Medicare Eligibility & Enrollment Specialist

MCS Health; San Juan (PR); On-site; USD 42,000 - 64,000; Full time

Job summary

MCS Health in Puerto Rico is seeking an Enrollment Specialist to ensure accurate and timely processing of enrollment, disenrollment, and eligibility changes in compliance with CMS, ASES, and internal policies. The role requires careful data review and coordination across multiple systems.

You will investigate discrepancies, respond to inquiries from internal departments, maintain audit-ready documentation, and support ongoing process improvements to meet regulatory timeframes.

Qualifications

• Bachelor's degree or higher required; six months to one year of enrollment processing experience preferred.
• Spanish language proficiency at an intermediate level; English basic proficiency required.
• Experience with Medicare Advantage enrollment processes and regulatory requirements is a plus.

Responsibilities

• Process enrollment, disenrollment, cancellation, reinstatement and coverage changes within SLAs and regulatory timeframes.
• Determine eligibility and establish appropriate effective dates and periods per CMS, ASES, and internal policies.
• Identify missing or inconsistent information, communicate with members and departments, and coordinate returns and notifications.

Skills

Spanish – Intermediate

English – Basic

Education

Bachelor's Degree

Associate’s Degree or 60–64 college credits

High School Diploma or Technical Course

Job description

MCS Health in Puerto Rico is seeking an Enrollment Specialist to ensure accurate and timely processing of enrollment, disenrollment, and eligibility changes in compliance with CMS, ASES, and internal policies. The role requires careful data review and coordination across multiple systems.

You will investigate discrepancies, respond to inquiries from internal departments, maintain audit-ready documentation, and support ongoing process improvements to meet regulatory timeframes.