Enrollment Specialist

The Enrollment Specialist plays a critical role in supporting Hometown Health's mission by guiding individuals through the enrollment process across multiple insurance product lines, including Employer Group, Individual and Family, Self-funded, and Medicare. This position requires a detail-oriented and customer-focused individual who can clearly communicate complex insurance information and ensure accurate processing in compliance with industry rules and regulations. The Enrollment Specialist will serve as a key point of contact for members and partners, helping to facilitate a smooth and efficient enrollment experience. Preference will be given to candidates with prior insurance experience and a strong understanding of enrollment procedures within a regulatory environment.

The Enrollment Specialist will be responsible for successfully verifying eligibility and complete all enrollment transactions for all segments of the business.

The position responsibilities include:

* Strict adherence to all Federal and State regulations and our State of Nevada department of insurance guidelines, Centers for Medicare & Medicaid Services (CMS) Medicare Managed Care Manual.

* Explain program details, eligibility requirements, and enrollment deadlines effectively for accurate and complete submissions.

* Ensuring reconciliation of all enrollment transactions to the enrollment forms to verify appropriate family coverage and tier match Hometown Health system.

* Working closely with our group administrators/contacts and members to ensure that enrollment is processed timely and accurately to avoid delay of enrollment, termination or disruption of their benefit plan when information received is not complete.

* Serve as the primary point of contact for individuals navigating the enrollment process, providing clear and accurate information via phone, email, internal company applications.

* Collaborate with internal teams (e.g., customer service, operations, compliance) to resolve enrollment-related issues, managing workloads independently as well as part of a team.

* Participates with Enrollment Analyst to create processes to maximize accuracy and quality measures required for departmental success.

* Works on multiple complex transactions with high quality results and adherence to deadlines.

* Manages Employer group and member relationships ensuring enrollment is processed timely and accurately to avoid delay of enrollment, termination or disruption of their benefit plan when information received is not complete.

* Maintain regular communication with Leadership, Department Analysts and internal/external customers.

* Verifying eligibility in multiple databases, including but not limited to the Medicare Advantage Prescription Drug (MARx) system, Group Eligibility Provision, Evidence of Coverage Document, Group Subscription Agreement, Group Self-Funded Summary * Plan Document, Departmental policies & procedures, Provider Directory before coding and entering membership into the Hometown Health's managed care information system.

* Performing critical thinking and analysis in determining the appropriate enrollment application has met the necessary criteria.

* Performs special projects including but not limited to system implementations as assigned by Leadership.

* Works directly with Department Lead and Supervisor on other enrollment related projects as assigned i.e. implementing electronic file.

* Adherence to changes in business which may include changes in Plan Document, Departmental policies & procedures, before coding and entering membership into the Hometown Health's managed care information system.

* Provide excellent customer service and build positive relationships

Type a minimum of 45+ WPM adjusted for error. Must have strong computer skills, including but not limited to, expert level understanding of Microsoft Office Suite, including Outlook, intermediate skills in Excel spreadsheets and formulas in addition to possessing basic Word skill

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working level knowledge of the English language, including reading, writing, and speaking. High School Diploma or equivalent required. Excellent verbal and written communication skills. Computer literacy, intermediate word processing/excel spreadsheet skills and 45+ wpm typing ability essential.

Experience:

2+ years of experience in enrollment, customer service, and/or administrative support role required. Experience in an insurance setting preferred.

License(s):

None.

Certification(s):

None.

Computer / Typing:

Must have within 90 days the ability to use the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.