Enrollment Specialist

Enrollment Specialist

The Enrollment Specialist is responsible for accurately and promptly processing and maintaining membership and employer data for GHC-SCW members and group accounts, including those related to Medicare and Medicaid. This role also involves participating in premium billing processes and handling a high volume of inquiries from employer groups, members, and providers concerning eligibility status.

The Enrollment team values collaboration, curiosity, continuous learning, and exceptional customer service. Employees are encouraged to take initiative, ask questions, and contribute ideas that improve processes and the member experience.

Schedule and Work Arrangement

This is a full-time position with work hours scheduled Monday - Friday. Employees may be assigned to either an 8:00 am - 4:30 pm or 8:30 am - 5:00 pm shift. Occasional schedule adjustments may be required to meet departmental and business needs. This position is primarily based on-site at the GHC-SCW Administrative Office. Employees are eligible to work remotely on Fridays.

GHC-SCW is committed to supporting a positive work-life balance while fostering a collaborative team environment. Employees benefit from a structured schedule with no evenings, weekends, or holiday work required for this position. Team members receive comprehensive training, ongoing support, and opportunities to expand their knowledge and skills within the organization.

GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid short-term disability, long-term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more.

Job Specific Minimum Qualifications

1. High school graduate or equivalent is required.
2. A minimum of one (1) year of administrative office experience is required. Experience in enrollment, billing or in an insurance or HMO related environment is preferred.
3. Extensive knowledge of and/or ability to learn Medicare, Medicaid, Federal and State enrollment regulations required.
4. Knowledge of and/or ability to learn procedures and practices related to HMO, medical services billing and enrollment, and knowledge of and/or ability to learn insurance enrollment software such as EPIC is required.
5. Knowledge of computers including ability to use various software packages such as MS Office Suite, email, and scheduling is required. Experience in the operation of a PC, and 10-key adding machine is preferred.
6. Ability to prioritize workload during heavy workload periods is required.
7. Ability to communicate effectively orally and in writing is required.
8. Ability to maintain patient confidentiality required. Knowledge of or ability to learn HIPAA requirements.
9. Excellent customer service skills and the ability to work with diverse populations are required, including strong listening skills both on the telephone and in person.
10. Ability to work independently is required.
11. Ability to file numerically and alphabetically is required.
12. Ability to analyze, write, plan, explain and investigate is required.
13. Ability to use a keyboard extensively is required, including the ability to accurately type 40 w.p.m.
14. Ability to sit extensively, stand, kneel, and lift intermittently is required.
15. Ability to lift a minimum of 25 pounds is required.
16. Visual acuity is required.
17. Ability to work irregular hours and overtime when needed is required.
18. Ability to work harmoniously and cooperatively with all personnel and the public is required.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude.

Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.

Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values:

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

We believe:

Healthcare is a human right.

In treating all people with dignity and respect.

There is strength in diversity.

Equity celebrates our humanity.

We are better together.

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.