Enrollment Specialist - Medicare Advantage Associate

Role Description Enrollment Specialist - Medicare Advantage Associate Who We Are UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all. We have a strong global presence and a dedicated workforce of over 4000 people spread across the world. Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively. You Are The Enrollment Specialist is responsible for assessing the client’s enrollment needs using a structured requirements process (gathering, analyzing, documenting, and managing changes) to identify the business priorities. The Opportunity

• Plans, organizes, directs, and monitors enrollment activities for clients.
• Adheres to project plans and schedules, and identifies goals, objectives, and risks related to enrollment implementation.
• Interfaces with various departments, senior management, and external individuals providing value and support for continuous improvement.
• Ensures that expectations are developed, controlled, and executed in a timely manner.
• Identifies opportunities and implements solutions for workflow, system, and other process improvements.
• Synthesizes complex data, information, and reports into clear and simple ideas.
• Develops user test cases/system integration testing and validates test results during testing.
• Maintains professional and technical knowledge by attending workshops, reviewing CMS publications, and benchmarking best practices.
• Creates correspondence for and sends to members or designated entities.
• Monitors enrollment correspondence and transactions sent to ensure accuracy and timeliness based on CMS, department, and corporate requirements.
• Assists and oversees the membership and revenue reconciliation processes including discrepancy resolution.
• Identifies and reports trends and issues and provides resolution.
• Supports and participates in system testing and requirements gathering related to operational readiness updates based on system enhancements, CMS software releases, and as needed.
• Reviews and submits audit documentation to CMS and/or its designee.
• Monitors and triages reports and correspondence including eligibility files to downstream systems, error reports, and returned correspondence.
• Provides and implements quality and process improvement initiatives and assists in the creation and implementation of policies, procedures, and workflows.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Need

• HS Diploma
• Relevant combination of education and experience may be considered in lieu of degree.
• Continuous learning, as defined by the Company’s learning philosophy, is required.
• Certification or progress toward certification is highly preferred and encouraged.
• Two years experience in an Enrollment environment or equivalent experience which provides the necessary skills, knowledge, and abilities.
• Experience in the health care industry or managed care is preferred.
• Knowledge of Medicare Advantage processes and Centers for Medicare & Medicaid Services (CMS) guidelines.
• Ability to communicate and build relationships across teams at all levels of the organization.
• Excellent quantitative skills and ability to interpret data from multiple sources.
• Excellent analytical, organizational, problem solving, verbal, and written communication skills.
• Ability to be flexible in a fast paced environment and adaptable to change.
• Ability to effectively prioritize, coordinate, and lead activities.
• Strong working knowledge of Microsoft office products.
• Ability to work independently, within a team environment, and with multiple priorities.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below. Role Location : Remote

Compensation

Range : $22 - $25 per hour

Benefits

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