Health Plan Enrollment Specialist

Our client, a nonprofit organization, is seeking an Health Plan Enrollment Specialist to support participant eligibility and health coverage administration. This role will assist participants with coverage questions, maintain eligibility records, coordinate with insurance providers, and support enrollment, COBRA, retiree, and dependent coverage processes.

Key Responsibilities

• Respond to participant and representative inquiries regarding eligibility and health coverage.
• Assist with the open enrollment process.
• Maintain participant and dependent eligibility records, including additions, terminations, reinstatements, and coverage changes.
• Coordinate with insurance providers to update participant and dependent coverage.
• Process and establish coverage for retirees, divorced spouses, and surviving spouses.
• Set up COBRA and self-pay coverage when applicable.
• Monitor vendor eligibility discrepancy reports and resolve coverage issues.
• Review and follow up on dependent documentation, Coordination of Benefits, and other eligibility requirements.
• Prepare correspondence related to eligibility issues and required documentation.
• Reconcile vendor invoices and premiums and process applicable refunds.
• Review eligibility appeals involving premiums, dependent additions, coverage changes, COBRA events, and open enrollment.
• Perform reconciliations related to the Retiree Drug Subsidy (RDS), Medicare Drug Subsidy program, and CMS Section 111.

Qualifications

• Bachelor’s degree preferred.
• 2-3 years of customer service experience in group health insurance preferred.
• Excellent written and verbal communication skills.
• Strong analytical and mathematical skills.
• Excellent organizational skills with strong attention to detail and accuracy.
• Proficiency in Microsoft Word and intermediate knowledge of Excel.
• Ability to prioritize workload and meet deadlines.
• Ability to work independently with minimal supervision.