Commercial Enrollment Specialist II

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Commercial Enrollment Specialist II based in the United States. We are seeking a detail-oriented Commercial Enrollment Specialist II to support accurate member enrollment, billing, and eligibility administration within the healthcare industry. This fully remote, full-time position offers the opportunity to contribute to the smooth operation of Medicare Advantage enrollment processes while helping resolve complex discrepancies and system rejections. You will work with enrollment transactions, regulatory requirements, and Centers for Medicare & Medicaid Services (CMS) guidelines to maintain accurate member records and ensure operational compliance. The role also involves investigating enrollment issues, preparing case documentation for review, and reconciling membership reports. Working closely with team members and management, you will help maintain service quality, improve processes, and support operational performance. This opportunity is ideal for a collaborative professional with Medicare enrollment experience who enjoys problem-solving, continuous learning, and helping others succeed Accountabilities - Prepare, process, and maintain member enrollment and disenrollment requests, ensuring accuracy and timely completion. - Verify and maintain applicable eligibility requirements in accordance with relevant regulations and established procedures. - Review and process CMS transactions while ensuring compliance with Medicare Advantage enrollment guidelines. - Review Medicaid eligibility and complete the required verification processes where applicable. - Investigate and resolve enrollment system rejections in accordance with regulatory requirements and client-specific guidelines. - Research and resolve enrollment and billing discrepancies, maintaining accurate member data and supporting appropriate corrections. - Build and maintain case files for enrollment-related issues requiring submission to the relevant CMS contractor for review, approval, and resolution. - Reconcile membership reports as required by CMS and analyze enrollment data to identify discrepancies and support accurate reporting.

- Monitor operational performance indicators, including service-level agreements (SLAs) and key performance indicators (KPIs), and present findings in a structured, clear manner. - Complete all required training provided by the employer and client to maintain current knowledge and meet performance expectations. - Mentor junior team members, share knowledge, and contribute to a collaborative and productive working environment. - Participate in special projects, including process documentation, team training, quality reviews, and other initiatives assigned by management. - Maintain regular communication with management regarding issues, concerns, case accuracy, and quality improvement opportunities. - Perform additional duties and support projects as assigned. Requirements: - High school diploma or equivalent required. - Three to five years of professional experience processing Medicare enrollment transactions. - Thorough understanding of Medicare Advantage products, CMS transaction files, and applicable enrollment rules and guidelines. - Experience using CMS interfaces and systems to manage Medicare Advantage enrollment and billing functions. - Experience with enrollment reconciliation, discrepancy resolution, and maintaining accurate member information. - Ability to analyze enrollment reconciliation data, evaluate operational performance, and prepare reports on SLAs, KPIs, and other relevant metrics. - Strong analytical and problem-solving skills, with the ability to present findings clearly and in a structured format. - Excellent attention to detail and a commitment to accuracy, quality, and regulatory compliance.