Enrollment Services - Enrollment Specialist - Commercial

JOB SUMMARY: Responsible for processing advanced enrollment and membership transactions, such as report review, transaction reconciliation, renewal and PCP routes, new group audits, system updates, correspondence, notices, prior coverage requests, ID card and output audits, and HICS case resolution. Maintains policies, procedures, and process documentation while adhering to service level agreements, audit-reviewed processes, and applicable regulatory guidance to support timely, accurate, and compliant enrollment operations.

KEY RESPONSIBILITIES:

• Process advanced employer group enrollment and membership transactions; prepare and audit New Group, Provider and renewal routes.
• Review and process enrollment reports to identify required system updates, corrections, reconciliations, or escalations.
• Reconcile enrollment transactions across systems, reports, source documentation, and membership records to ensure accurate and timely updates.
• Administer renewal routes, PCP routes, and new group audits to support accurate employer group setup, renewal processing, and ongoing membership maintenance.
• Create, review, and generate enrollment-related correspondence, notices, prior coverage requests, and other member or group communications.
• Audit ID cards, correspondence, and related output files prior to vendor release or distribution to ensure accuracy and prevent customer impact.
• Research, document, and resolve HICS cases related to Marketplace enrollment.
• Perform system updates tied to transactional activity, report findings, renewals, group changes, and approved membership corrections.
• Review, maintain, and update departmental policies, procedures, and process documentation to promote consistent operations and audit readiness.
• Adhere to service level agreements, internal audit-reviewed processes, and applicable state and federal regulatory guidance to ensure timely, accurate, and compliant enrollment operations.
• Perform other job-related duties as required or assigned. 

QUALIFICATIONS:

• Possess strong oral and written communication skills.
• Self-motivated with the ability to handle multiple tasks and work with minimal supervision
• Strong organizational skills.
• Ability to work effectively with personnel at various levels.
• Must have high attention to detail.
• Successful completion of Health Care Sanctions background check.
• Proficient in Microsoft office applications.

EDUCATION/EXPERIENCE:

• High school diploma or equivalency.
• A minimum of three years working in an administrative function for a health care institution, insurance company or medical group preferred.