Enrollment Services - Enrollment Specialist - Commercial

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 42,000 - 54,000; Full time

Job summary

CommunityCare HMO Inc. seeks an experienced enrollment operations professional to process advanced employer group enrollment and membership transactions, perform audits, and ensure accurate, timely updates across systems.

You will review reports, reconcile data, administer renewal and PCP routes, generate notices, and maintain policy documentation while complying with SLAs and regulatory guidance. Strong communication and attention to detail are essential.

Qualifications

• Requires strong communication and organizational skills.
• Ability to work with multiple tasks with minimal supervision.
• Experience in administrative roles within healthcare or insurance preferred.

Responsibilities

• Process enrollment transactions and audits for groups and members.
• Review enrollment reports and apply system updates or corrections.
• Reconcile transactions across systems and records to ensure accuracy.
• Manage renewal and PCP routes and conduct new group audits.
• Generate enrollment-related notices and correspondence.
• Audit output files and ID cards prior to release.
• Document and resolve HICS cases related to enrollment.
• Maintain policies and process documentation for audit readiness.
• Adhere to SLAs and regulatory guidance in enrollment operations.
• Perform other duties as assigned.

Skills

Strong oral and written communication

Self-motivated with ability to multita

Strong organizational skills

Ability to work with personnel at var

High attention to detail

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

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.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin