POSITION SUMMARY

The Enrollment and Eligibility Specialist (EES) is responsible for preparing, processing and maintaining new Member or Group enrollments and related data. The Enrollment and Eligibility Specialist will load new Member data into the enrollment and eligibility system and enter required changes in a timely and accurate manner. The Specialist will respond to Member eligibility or group questions and verify Member enrollment status to ensure new enrollments and updates are properly executed. The Specialist may need to analyze data from several sources to determine eligibility changes and to resolve enrollment or eligibility errors or other related issues that arise. The Enrollment Specialist will partner cross-functionally with various operational business units while supporting departmental objectives within company and regulatory guidelines. The EES will be a subject matter expert on Community Health Options health insurance interfaces on multiple distribution pathways; including the company’s online Storefront, the State Based Marketplace, and Agent/Broker relationships.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Prepares, processes and maintains new Member direct enrollments and Special Enrollment Period enrollment
• Maintains working knowledge of On Exchange Member enrollment received via the State Based Marketplace
• Reviews, reconciles and analyzes State Based Marketplace enrollment and eligibility reports and compares data to validate eligibility in our system
• Researches and responds to State Based Marketplace CoverME cases within timeframe required.
• Processes Enrollment & Eligibility Salesforce cases generated by internal Health Options departments and external Member and Group inquiries
• Reviews and processes daily file reject transactions to several partner systems
• Services the internal support phone line as well as the Group Invoice support phone line
• Assists Group Administrators with Group policy invoice concerns related to Group employee eligibility

• Coordinates enrollment/disenrollment/eligibility activities with the organization’s business partners
• Researches and responds to written Member and client inquiries by phone, mail or email
• Documents case work performed to provide visibility to multiple departments
• Performs quality review and tracking of printed letters often coordinating directly with our print vendor(s), in addition to tracking of print jobs and expenses.
• Complies with all Federal and State laws and regulations and industry practices regarding privacy of Member and client information.
• Performs other responsibilities as assigned

JOB SPECIFIC KEY COMPETENCIES (KSAs)

• Able to analyze and interpret verbal and written instructions
• Ability to effectively present information in a clear and concise manner
• Ability to multi-task using multiple computer systems and screens with strong organizational and time management skills
• Ability to incorporate feedback to further professional development
• Must be able to work in a fast-paced environment and adapt to change
• Strong verbal and written communication skills with the ability to work as part of a goal-oriented team
• Knowledge of Microsoft Office products

DIVERSITY, EQUITY, AND INCLUSION STATEMENT

Community Health Options is committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion (DEI). Our human capital is the single most valuable asset we have. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent our employees invest in their work represents a significant part of not only our culture, but our reputation and achievement as well. Community Health Options DEI initiatives are applicable, but not limited to, our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of DEI, which encourages and enforces: