Enrollment Specialist

Talentify; Marshfield (WI); On-site; USD 36,000 - 54,000; Full time

Job summary

Talentify is seeking an Enrollment Specialist for our Marshfield, WI location within a healthcare service environment. You will interact with members, applicants, providers, and agents by phone to resolve inquiries and ensure accurate benefit information and enrollment processing.

Key responsibilities include handling CMS/ACA-related questions, maintaining member records, and guiding customers through plan changes using scripted CMS guidelines. A strong customer service background is required.

Qualifications

• High School Diploma or equivalent.
• Two years of customer service experience.
• Experience in a health insurance call center.
• Strong verbal and written communication under pressure.

Responsibilities

• Ensure positive customer interactions with one major product line.
• Interact with members, applicants, providers, and agents by telephone.
• Identify customer concerns and resolve inquiries promptly.
• Provide accurate benefit, coverage, premium and claims information by phone or in person.
• Coordinate referrals for care outside the service area to ensure timely medical care.
• Answer CMS test calls accurately to ensure CMS compliance.
• Assist FFM members with updating financial and subsidy information for ACA compliance.
• Document interactions with members electronically for accurate records.
• Use electronic systems to verify wellness benefits and reimbursements.
• Troubleshoot online portal and secure email issues for members.
• Assist members in filing complaints or grievances per guidelines.
• Participate in coaching to maintain metrics and accuracy goals.
• Maintain regular attendance to perform essential functions.
• Review ongoing competency and skill maintenance for the role.
• May assist Medicare Advantage members with plan changes using CMS scripts.
• Other duties as assigned.

Skills

Customer service

Verbal communication

Written communication

Education

High School Diploma or equivalent

Job description

Our client, a Healthcare company, is looking for an Enrollment Specialist for their Marshfield, WI location.

Responsibilities:

• Ensure positive customer interactions with one major product line
• Interact with members, applicants, providers, and agents via telephone.
• Identify the customer's concern and appropriately research and resolve the inquiry in a timely manner.
• Provides accurate and timely answers to benefit, coverage, premium and claims questions in person, via telephone to ensure member satisfaction.
• Assists with coordinating out-of-area or non-affiliated provider referrals for members requiring care outside of the Security Health Plan service area to ensure members receive needed medical care in a timely fashion.
• Answers Center for Medicare and Medicaid Services (CMS) test calls in an accurate and timely manner to ensure compliance with CMS guidelines.
• Assists Federally Facilitated Marketplace (FFM) members in updating financial and subsidy information to ensure compliance with the federal government and the Affordable Care Act (ACA).
• Documents interactions with members electronically to ensure member records are accurate and available for future use of other staff.
• Utilizes electronic systems to verify and assist members with questions or concerns regarding wellness benefits to ensure members are reimbursed correctly for wellness activities.
• Troubleshoots online portal and secure email issues for members to ensure they are able to access and view information electronically.
• Assists members in filing complaints or grievances using internal and/or federal guidelines to ensure complaints are handled and resolved correctly.
• Participates in continual coaching to maintain call volume, processing metrics and accuracy goals to ensure compliance with accreditation guidelines.
• Regular attendance is required in order to carry out the essential functions of the position.
• Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge and abilities to perform, within scope, role specific functions.
• May be asked to assist with current Medicare Advantage members with plan changes using documented scripts provided by the Centers for Medicare and Medicaid Services (CMS) to ensure members are enrolled in the correct plan.
• Other duties as assigned.

Requirements:

• High School Diploma or equivalent
• Two years' experience with customer service.
• Demonstrated proficiency with handling high-pressure situations and with verbal and written communication.
• Experience working in a health insurance call center.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

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