Enrollment Team Lead

UST HealthProof, Inc.; Northern (KY); Hybrid; USD 95,000 - 103,000; Full time

Job summary

HealthEdge is seeking an Enrollment Team Lead to supervise enrollment operations, manage discrepancy queues, and mentor onshore/offshore specialists across time zones in a remote US setting.

You will ensure CMS regulatory alignment, generate client reports, and drive process improvements within the Enrollment Operations unit, reporting to the Enrollment Manager.

Qualifications

• 7+ years’ experience in related field across processes and/or health care.
• Strong knowledge of Medicare Advantage and CMS enrollment guidelines.
• Experience with CMS interfaces and enrollment/billing systems.
• Ability to analyze enrollment data, report SLAs and KPIs.
• Bachelor’s degree; equivalent experience considered.

Responsibilities

• Oversee enrollment workflows, discrepancy queues, RPC, LEP, and JIRA tickets.
• Lead onboarding and coaching for onshore/offshore enrollment specialists.
• Prepare client reports, maintain inboxes, and delegate tasks.
• Ensure regulatory compliance and data quality across operations.

Skills

CMS regulations understanding

Data analysis & KPI reporting

Regulatory compliance

Team collaboration

Problem solving

Education

Bachelor’s degree

Tools

MS Access

Excel

Word

PowerPoint

Job description

Overview

Overview:

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members.

UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

UST HealthProof is seeking an Enrollment Team Lead to report to the Enrollment Manager. The Enrollment Team Lead is responsible for supporting key processes to ensure the smooth operation of the Enrollment Operations Business Unit. The Enrollment Team Lead will help oversee both onshore and offshore enrollment specialists, focusing on tasks that require a higher level or analytical expertise. Responsibilities include managing and processing discrepancy queues, RPC, LEP, briefcases, and JIRA tickets, as well as assisting with audits, overseeing correspondence submissions, generating client reports, maintaining inboxes, and delegating tasks. This position plays a critical role in supporting client value delivery within the Business Unit.

As an Enrollment Team Lead at UST HealthProof, your responsibilities would include:

• Navigating and effectively interpreting regulations and guidance in accordance with the CMS Manual System and other regulatory agencies guidelines
• Assisting with the development and/or review of policies and procedures to ensure compliance with CMS regulations
• Assisting in researching, analysing, and disseminating new and existing CMS guidance and communications to cross-functional business units and internal/external stakeholders
• Assisting and partnering with business units with the development and/or improvement of workflows and business processes to improve controls and overall quality
• Assisting with the development and recommendations for ongoing improvement of core processes
• Assisting onshore and offshore personnel by answering questions, supplying information, provide coaching / training, as appropriate
• Recommending process improvements in support of positive SLA results
• Assisting the Enrollment by writing and maintaining documents related to Enrollment’s internal functions
• Serving as a Lead Enrollment SME

You bring:

• 7+ years’ experience in a related field, typically in two subject areas (e.g. process improvement, project planning, health care economics, health care policy, statistical modelling, business decisions, analysis, or business management)
• A thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines
• Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions
• Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
• Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of a degree.
• Proficient in current industry standard PC applications and systems (e.g., Access, Excel, Word, and PowerPoint)
• Willingness to learn
• Team collaborator
• Significant creativity and flexibility.
• Strong work ethic

Geographic Responsibility: Remote, US

Type of Employment:Full-time, permanent

Work Environment:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employeeis occasionally required tomove around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

• Work across multiple time zones in a hybrid or remote work environment.

• Long periodsof time sitting and/or standing in front of a computer using video technology.

• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skillsrequired. HealthEdge reserves the right tomodify, add, or remove duties and to assign otherdutiesas necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.Candidates maybe requiredto go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women,veteransand persons with disabilities.

#LI-Remote

**The annual US base salary range for this position is $95,000 to $103,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education.