Enrollment Specialist I/II/III/IV

Excellus BCBS•De Witt, AR

2d•$20 - $33

About The Position

Under the direction of assigned management, and after successful completion of all training phases, the Enrollment Specialist performs enrollment processing and servicing in accordance with Health Plan enrollment regulations, underwriting guidelines, applicable government regulations, and HIPAA requirements. The role focuses on prompt, accurate, and efficient service for broker, member, and group administrator inquiries across product lines. Inquiries may arrive by telephone, email, written correspondence, lobby walk-ins, or on-site employer group visits. The B version of the role requires regular phone work. Responsibilities vary by level. Level I handles subscriber enrollment operations for government programs and small, mid-sized, and large employer groups, including new group and member enrollment, renewals, member movements, eligibility transactions, research, and customer inquiries. Level II adds group enrollment processing, Designated Record Set requests, enrollment adjustments, phone-line coverage, team support, process improvement, and procedure updates. Level III adds complex account processing, subject-matter expertise, mentoring, broad cross-training, issue resolution, and possible support for system releases and production validation. Level IV adds testing and procedure development for new products and work efforts, resolution of complex and sensitive cases, and representation of the department on corporate projects and cross-functional work groups. The role requires working with internal and external customers and business partners, maintaining member privacy, meeting quality, productivity, compliance, service-level, and processing-time targets, and supporting the company’s mission, values, and Code of Conduct. The position may involve work in a traditional office or home office and travel across the enterprise. Remote work may be available on a case-by-case basis.

Requirements

High school diploma or equivalent.
Level I: Two years of health insurance or related operations work experience is preferred.
Level II: Three years of health insurance or related operations work experience is preferred; a rating of “Performing” or above for at least 12 months is required.
Level III: Four years of health insurance or related operations work experience is preferred; a rating of “Performing” or above for at least 12 months is required.
Level IV: Five years of health insurance or related operations work experience is preferred; a rating of “Performing” or above for at least 12 months is required.
Solid written and verbal communication skills; strong communication skills are specified for Level III.
Organizational, analytical, reasoning, problem-solving, and time-management skills appropriate to the level.
Basic computer proficiency, including Microsoft Office Suite; strong proficiency, including Excel, for Level III.
Attention to detail and accuracy.
Ability to multitask, understand customer needs, navigate computer screens, and document inquiries.
Level II: Ability to take accountability for issues and resolutions with minimal supervision, think globally, and recognize team opportunities.
Level III: Ability to mentor and support new hires and peers and perform management-assigned tasks requiring advanced problem-solving skills.
Level IV: Ability to independently resolve complex and escalated issues and lead management-assigned tasks requiring advanced problem-solving across multiple areas.
For the B version at every level: Ability to actively listen while taking notes and to be on the phone regularly.
Ability to meet performance metrics, arrive at work on time as scheduled, and communicate orally.
Ability to work while seated at a desk, viewing a computer and using a 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

Relevant health insurance or related operations experience at the applicable level is described as preferred.

Responsibilities

Process and service member and group enrollments, renewals, changes, cancellations, reinstatements, and eligibility transactions using multiple health plan systems.
Communicate and coordinate with Enrollment Management, Account Services, Sales, Finance/Underwriting, Claims, Customer Care, members, groups, brokers, consultants, and other business partners.
Review enrollment activity and supporting documentation for accuracy and compliance with processing regulations and guidelines.
Research, interpret, and respond to customer and partner inquiries about products, services, policies, and eligibility through applicable communication channels.
Review, validate, update, and resolve transaction errors from electronic and paper sources affecting eligibility interfaces.
Identify and address work items and inquiries within department service-level agreements; prioritize aged, performance-guarantee, urgent, complex, and sensitive cases as applicable to level.
Meet productivity, accuracy, compliance, member-touchpoint, and CMS processing-time requirements while protecting member privacy.
Attend training and meetings, and share relevant information and knowledge with the team.
At Level II, process group enrollment and group information changes; handle Designated Record Set requests; adjust or triage enrollment cases; request additional information; support and cross-train team members; staff enrollment phone lines; identify process trends and recommend improvements; and assist with operating manuals and desk-level procedures.
At Level III, mentor and collaborate with team members, serve as a departmental subject-matter expert, cross-train across tasks and lines of business, process complex accounts, reprioritize daily work for urgent cases, resolve eligibility inquiries, remove operational barriers, and potentially assist with system releases and production validation.
At Level IV, create test cases, test processes, and document procedures for new products and work efforts; research complex cases to identify root causes and complete resolutions; handle complex or sensitive cases; and represent the department on corporate projects and cross-functional work groups, advising teams and leadership on impacts to productivity and quality.
Perform other functions as assigned by management.