Senior Enrollment and Eligibility Representative

Optum; Hyderabad; On-site; INR 4,952,000 - 7,238,000; Full time

Job summary

UnitedHealth Group is seeking a Senior Enrollment and Eligibility Representative to manage complex enrollment and eligibility tasks in a US healthcare environment. You will handle inquiries via email and phone, ensure data accuracy, and support process improvements.

The role requires strong communication, data integrity, and the ability to work independently in a fast-paced setting. Join a diverse team and contribute to delivering high-quality health services.

Qualifications

• 2+ years of experience in Eligibility, Enrollment, EDM, Customer Service, or Healthcare Operations.
• Solid knowledge of US Healthcare, Eligibility, Enrollment, and Benefits Administration.
• Proficiency in Microsoft Office Suite (Outlook, Excel, Word, PowerPoint).
• Proficiency in email handling, customer correspondence, and voice support.
• Proven analytical and problem-solving capabilities.
• Ability to navigate multiple systems and applications simultaneously.
• Excellent verbal and written communication skills.
• Customer-centric mindset and active listening abilities.
• High attention to detail and commitment to quality.
• Ability to work independently with minimal supervision.
• Ownership, accountability, and professional integrity.
• Ability to handle work pressure.
• Effective collaboration and teamwork skills.
• Ability to manage competing priorities and deadlines.
• Experience handling escalations and challenging interactions.

Responsibilities

• EDM Operations & Data Management: maintain and update member records in internal systems; perform data verification and audits; track customer interactions; identify data inconsistencies and risks; review plans, benefits and SOPs; ensure SLAs are met; maintain quality scores.
• Handle inquiries from customers, brokers, employer groups, and internal partners via email and voice support.
• Respond professionally to member and client concerns while maintaining high customer satisfaction.
• Follow up on unresolved cases and provide regular status updates.
• Act as a point of contact for escalated or complex cases.
• Analyze complex issues and determine appropriate resolutions independently.
• Apply business knowledge and guidelines to support decision-making.
• Proactively identify solutions for non-standard requests and process exceptions.
• Collaborate with cross-functional teams to resolve operational challenges.

Skills

Eligibility knowledge

US healthcare knowledge

Office suite

Email & voice support

Analytical skills

Multi-system navigation

Verbal & written comms

Customer-centric mindset

Attention to detail

Independent work

Ownership & accountability

Work under pressure

Teamwork

Prioritization

Escalation handling

Tools

Outlook

Excel

Word

PowerPoint

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Senior Enrollment and Eligibility Representative (2382729)

Senior Enrollment and Eligibility Representative - 2382729

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Enrollment & Eligibility Representative (EDM) is responsible for managing complex enrollment, eligibility, and member data management activities within the US Healthcare environment. The role involves handling customer, broker, client, and internal stakeholder inquiries through email and voice channels while ensuring accuracy, compliance, and service excellence. The incumbent will independently resolve moderately complex issues, support escalations, provide guidance to team members, and contribute to process improvement initiatives.

Primary Responsibilities:

• EDM Operations & Data Management
  • Maintain and update member records accurately in internal systems
  • Perform data verification, quality checks, and audits to ensure data integrity
  • Track and document all customer interactions, resolutions, and actions taken
  • Identify and report data inconsistencies, operational risks, and process gaps
  • Review healthcare plans, benefits, policies, and SOPs to provide accurate resolutions
  • Ensure timely completion of transactions within established Service Level Agreements (SLAs)
  • Maintain quality scores and productivity targets as per business expectations
• Handle customer, broker, employer group, and internal partner inquiries through email and voice support
• Respond professionally to member and client concerns while maintaining high customer satisfaction
• Follow up on unresolved cases and provide regular status updates
• Act as a point of contact for escalated or complex cases
• Problem Solving & Decision Making
  • Analyze complex issues and determine appropriate resolutions independently
  • Apply business knowledge and established guidelines to support decision-making
  • Proactively identify solutions for non-standard requests and process exceptions
  • Collaborate with cross-functional teams to resolve complex operational challenges
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• 2+ years of experience in Eligibility, Enrollment, EDM, Customer Service, or Healthcare Operations
• Solid knowledge of US Healthcare, Eligibility, Enrollment, and Benefits Administration
• Working knowledge of Microsoft Office Suite (Outlook, Excel, Word, PowerPoint)
• Proficiency in email handling, customer correspondence, and voice support
• Proven solid analytical and problem-solving capabilities
• Proven ability to navigate multiple systems and applications simultaneously
• Proven excellent verbal and written communication skills
• Proven solid customer-centric mindset and active listening abilities
• Proven high attention to detail and commitment to quality
• Proven ability to work independently with minimal supervision
• Proven solid ownership, accountability, and professional integrity
• Proven ability to handle work pressure
• Proven effective collaboration and teamwork skills
• Proven ability to manage competing priorities and deadlines
• Proven professional handling of escalations and challenging customer interactions

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone- of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.