Remote Enrollment Resolution Specialist I

Capital District Physicians Health Plan Inc; Town of Clinton (NY); On-site; USD 29,000 - 48,000; Full time

Job summary

Capital District Physicians Health Plan Inc is seeking an Enrollment Resolution Examiner to resolve complex enrollment and billing reconciliation issues with internal teams and external customers, including state and federal agencies.

The role spans multiple enrollment operation areas with responsibilities across Level I and II, focusing on data accuracy, reporting, and process improvements while safeguarding member privacy. Strong analytical and communication skills are essential.

Qualifications

• Three years' experience with financial data or Health Insurance Enrollment experience, or an associate degree in finance, accounting, or similar discipline.
• Strong ability to establish constructive relationships with internal and external stakeholders.
• Ability to prioritize assignments and work accurately within deadlines.
• Solid written and verbal communication skills.

Responsibilities

• Reconcile enrollment and billing data across regulatory guidelines and Health Plan policies.
• Review and update member/subscriber/group documentation to resolve discrepancies.
• Prepare regular reports on processing and enrollment activity.
• Communicate with internal and external customers and provide supporting documentation.
• Support process improvements and cross-functional projects as needed.
• Maintain member privacy in accordance with policies.
• Process inventory across lines of business as required.

Skills

Analytical skills

Time management

Communication

Detail oriented

Office software

Education

Associate degree in finance or accounting

Tools

Microsoft Office Suite

Job description

Capital District Physicians Health Plan Inc is seeking an Enrollment Resolution Examiner to resolve complex enrollment and billing reconciliation issues with internal teams and external customers, including state and federal agencies.

The role spans multiple enrollment operation areas with responsibilities across Level I and II, focusing on data accuracy, reporting, and process improvements while safeguarding member privacy. Strong analytical and communication skills are essential.