Enrollment Specialist

Group Health Cooperative of South Central Wisconsin; Madison (WI); On-site; USD 30,000 - 45,000; Full time

Benefits offered by this job

Health and dental insurance

Paid short-term disability

Tuition reimbursement

Job summary

Group Health Cooperative of South Central Wisconsin seeks an Enrollment Specialist responsible for processing and maintaining membership data related to Medicare and Medicaid. The role includes premium billing and addressing inquiries from members and providers.

Candidates should have a high school diploma and at least one year of administrative experience. Strong communication and customer service skills are essential. A comprehensive benefits package is offered, including health and dental insurance.

Qualifications

• High school graduate or equivalent is required.
• A minimum of one (1) year of administrative office experience is required.
• Extensive knowledge of and/or ability to learn Medicare, Medicaid, Federal and State enrollment regulations required.

Responsibilities

• Process and maintain membership and employer data for GHC‑SCW members.
• Participate in premium billing processes.
• Handle inquiries from employer groups, members, and providers.

Skills

Customer service skills

Ability to communicate effectively

Knowledge of Medicare and Medicaid

Ability to work independently

Knowledge of office software (MS Office Suite)

Education

High school graduate or equivalent

Tools

Insurance enrollment software (EPIC)

Job description

Administration - 1265 John Q. Hammons Drive, Madison, Wisconsin, United States of America

Job Description

Under the general supervision and direction of the Enrollment Supervisor, the Enrollment Specialist is responsible for accurately and promptly processing and maintaining membership and employer data for GHC‑SCW members and group accounts, including those related to Medicare and Medicaid. This role also involves participating in premium billing processes and handling a high volume of inquiries from employer groups, members, and providers concerning eligibility status.

GHC‑SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well‑being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid short‑term disability, long‑term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more.

Job Specific Minimum Qualifications

• High school graduate or equivalent is required.
• A minimum of one (1) year of administrative office experience is required. Experience in enrollment, billing or in an insurance or HMO related environment is preferred.
• Extensive knowledge of and/or ability to learn Medicare, Medicaid, Federal and State enrollment regulations required.
• Knowledge of and/or ability to learn procedures and practices related to HMO, medical services billing and enrollment, and knowledge of and/or ability to learn insurance enrollment software such as EPIC is required.
• Knowledge of computers including ability to use various software packages such as MS Office Suite, email, and scheduling is required. Experience in the operation of a PC, and 10‑key adding machine is preferred.
• Ability to prioritize workload during heavy workload periods is required.
• Ability to communicate effectively orally and in writing is required.
• Ability to maintain patient confidentiality required. Knowledge of or ability to learn HIPAA requirements.
• Excellent customer service skills and the ability to work with diverse populations are required, including strong listening skills both on the telephone and in person.
• Ability to work independently is required.
• Ability to file numerically and alphabetically is required.
• Ability to analyze, write, plan, explain and investigate is required.
• Ability to use a keyboard extensively is required, including the ability to accurately type 40 w.p.m.
• Ability to sit extensively, stand, kneel, and lift intermittently is required.
• Ability to lift a minimum of 25 pounds is required.
• Visual acuity is required.
• Ability to work irregular hours and overtime when needed is required.
• Ability to work harmoniously and cooperatively with all personnel and the public is required.

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC‑SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.