Enrollment Specialist I/II/III/IV

Univera Healthcare • Rochester, NY

1d • $20 - $33

About The Position

Under the direction of assigned management, and after successfully completing all phases of training, the Enrollment Specialist performs enrollment core processing and servicing in accordance with HIPAA regulations, Health Plan Operations enrollment regulations, Underwriting Guidelines, and applicable government regulations. The role focuses on prompt, accurate, and efficient service for broker, member, and group administrator inquiries across all product lines. Inquiries may arrive by telephone, email, written correspondence, lobby walk-ins, or on-site visits with employer groups. The B version of the role requires regular phone work.

Responsibilities vary by classification level. Level I handles subscriber enrollment operations for government programs and small, mid-sized, and large employer groups. Level II adds group enrollment processing, designated record set requests, phone-line coverage, and support for teammates. Level III adds expertise across inventory areas, mentoring, complex account processing, and subject-matter expertise. Level IV adds complex and sensitive case resolution, test-case creation and process testing, procedures for new products and work, and representation on corporate projects and cross-functional work groups.

The role requires maintaining member privacy, meeting productivity, accuracy, compliance, service-level, member touchpoint, and applicable CMS processing-time targets. Work may be performed in a traditional office or, when approved case by case, remotely. The position may require travel across the enterprise.

Requirements

• Level I: High school diploma or equivalent.
• Level I: Two years of health insurance or related operations experience is preferred.
• Level II: Three years of health insurance or related operations experience is preferred, and a rating of “Performing” or above for at least 12 months.
• Level III: Four years of health insurance or related operations experience is preferred, and a rating of “Performing” or above for at least 12 months.
• Level IV: Five years of health insurance or related operations experience is preferred, and a rating of “Performing” or above for at least 12 months.
• Solid written and verbal communication skills; strong communication skills are specified for Level III.
• Organizational, analytical, and time-management skills; Level II additionally requires reasoning and problem-solving skills.
• Basic computer proficiency, including Microsoft Office Suite; Level III requires strong computer proficiency, including Excel.
• Attention to detail and accuracy.
• Ability to multitask while resolving customer concerns, navigating computer screens, and documenting inquiries.
• For the B version, ability to actively listen while taking notes and to work on the phone regularly.
• Level II: Ability to take ownership of issues and resolutions with minimal supervision, think globally, and recognize team opportunities.
• Level III: Ability to mentor and support new hires and peers, and assist with management-assigned tasks requiring advanced problem-solving.
• Level IV: Self-sufficient resolution of complex and escalated issues, and ability to lead management-assigned tasks requiring advanced problem-solving across multiple areas.
• Ability to work in a traditional office environment under fluorescent lighting, arrive on time as scheduled, meet minimum performance metrics, and communicate orally.
• Ability to sit at a desk and use a computer, keyboard, and mouse for three or more hours at a time.
• Ability to travel across the enterprise and work in a home office for continuous periods for business continuity.

Nice To Haves

• Health insurance or related operations experience at the level associated with the classification is preferred: two years for Level I, three years for Level II, four years for Level III, or five years for Level IV.

Responsibilities

• Process and maintain member enrollments, including new enrollments, member movements, benefit changes and renewals, cancellations, and reinstatements using multiple Health Plan, sales, marketplace, and enrollment systems.
• Review enrollment activity and related documents for accuracy and compliance with processing regulations and guidelines.
• Communicate with internal teams—including Enrollment Management, Account Services, Sales, Finance/Underwriting, Claims, and Customer Care—and with external customers, groups, brokers, consultants, and business partners.
• Research, interpret, respond to, and resolve enrollment and eligibility inquiries through telephone, email, written correspondence, walk-ins, and other communication methods.
• Review, validate, and update transaction errors from electronic and paper sources that affect eligibility interfaces.
• Identify issues and work items, meet department service-level agreements, and prioritize aged and performance-guarantee transactions according to established metrics.
• Maintain knowledge and accuracy across assigned inventory areas, attend training and meetings, and share information with the team.
• Meet productivity, accuracy, compliance, member touchpoint, and CMS processing-time measures while maintaining member privacy and reliable attendance.
• At Level II, process group enrollment and group information, handle Designated Record Set requests, triage enrollment adjustments, request additional information or verification, cross-train teammates, staff enrollment phone lines, and contribute to operating manuals or Desk Level Procedures.
• At Level III, mentor and collaborate with teammates, serve as a departmental subject-matter expert, cross-train across tasks, process complex accounts, adjust priorities for urgent cases, remove operational barriers, and assist with system releases and production validation.
• At Level IV, create test cases, test processes, document procedures for new products and work efforts, participate in end-user testing as requested, research and resolve complex or sensitive cases, and represent the department on corporate projects and cross-functional work groups.
• Advise project teams and leadership on how requirements may affect productivity and quality.
• Perform other functions as assigned by management.

Benefits

• Group health and/or dental insurance may be included in the total rewards package.
• Retirement plan may be included in the total rewards package.
• Wellness program may be included in the total rewards package.
• Paid time away from work may be included in the total rewards package.
• Paid holidays may be included in the total rewards package.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED