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Full-time
high school, bachelor degree
Posted 11d ago
~40 hrs/week
Responsibilities
The Enrollment Specialist is responsible for creating and maintaining member eligibility in the transactional system while ensuring compliance with CMS, DPW, and PID regulations. They also manage direct interactions with internal and external customers to resolve inquiries and process enrollment or disenrollment transactions.
Requirements
Candidates must have a high school diploma or equivalent, with a college degree preferred, and at least six months of customer service or call center experience. Proficiency in MS Office and the ability to interpret complex eligibility regulations are required for success in this role.
Full job description
UPMC Health Plan has an exciting opportunity for an Enrollment Specialist I position in the Medicare SNP Enrollment department. This is a full-time hybrid position based in the Pittsburgh/Erie area. While you'll primarily work remotely, you'll come into the office occasionally depending on departmental needs.
This position has a set rate of $20.70/hr.
The Enrollment Specialist will be responsible for the creation and maintenance of eligibility in the transactional system, responding to both internal and external customer inquiries, and resolving issues to meet or exceed service requirements. To successfully perform the role, an Enrollment Specialist must have a comprehensive understanding of enrollment regulations and complete all duties with strict regard to policies and procedures. Completes all duties with strict regard to policies and procedures set forth by Enrollment Services Manager, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID). Performs duties related to the processing and maintenance of all member requested transactions, include generation of required letters to ensure enrollment and/or disenrollment processes are completed compliantly. The role also involves direct interaction with internal and external customers to resolve inquiries and concerns including but not limited to outbound phone calls to members.
Responsibilities:
Understanding of varied and detailed enrollment and disenrollment requirements and processing rules based upon the product (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group, including, but not limited to, understanding and application of service areas by product.
Maintain employee/insured confidentiality.
Ability to analyze information to make appropriate decisions regarding enrollment/disenrollment, complying with applicable regulations and governance.
Interact with Sales staff to ensure all required date elements for completed application are received and any issues are addressed timely, in accordance with compliance requirements.
Ability to make eligibility determinations based on CMS (Part A/Part B Eligibility), DPW (Medical Assistance Eligibility), and/or PID requirements, in accordance with the application election period guidelines. Ability to accurately identify appropriate election period based upon analysis of beneficiary/member history and regulatory guidance.
Comprehension and application of eligibility regulations to process enrollment transactions and generation of corresponding letters to members. Must keep up to date with new regulations and guidance.
Process all types of enrollment and disenrollment transactions in accordance with company policies and procedures in a timely manner while meeting production and quality goals.
Initiation and generate of appropriate correspondence based on type of transaction processed, includes initiation of outreach requests and written correspondence (letters), as necessary.
Daily clerical responsibilities related to processing and electronic storage of member correspondence.
Identify areas of concern or trends that may compromise client satisfaction or compliance with government regulations.
Support team projects within Enrollment Services; other projects as assigned.
High school graduate or equivalent required, college degree preferred.
Minimum of six months of customer service and/or call center experience.
Ability to interpret and apply complex eligibility regulations as mandated by CMS, DPW, and PID.
Demonstrates good organizational, interpersonal, leadership and communication skills.
Attention to detail is critical to the success of this position, with skills in customer orientation.
Will need to manage multiple tasks and projects.
MS Office/PC skills required.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
Related keywords
Enrollment SpecialistMedicare SNPUPMC Health PlanEligibilityCMSDPWPIDHMOPPOEPOPDPComplianceCustomer ServiceCall CenterData ProcessingRegulatory Guidance
UPMC is a world-renowned, nonprofit health care provider and insurer committed to delivering exceptional, people-centered care and community services. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is shaping the future of health through clinical and technological innovation, research, and education. Dedicated to advancing the well-being of our diverse communities, we provide nearly $2 billion annually in community benefits, more than any other health system in Pennsylvania. Our 100,000 employees — including more than 5,000 physicians — care for patients across more than 40 hospitals and 800 outpatient sites in Pennsylvania, New York, and Maryland, as well as overseas. UPMC Insurance Services covers more than 4 million members, providing the highest-quality care at the most affordable price. To learn more, visit UPMC.com.
Offices: US Steel Tower, 600 Grant Street, Pittsburgh, PA 15219, US
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Based on 2822 listings with disclosed salaries, most healthcare jobs in Pennsylvania pay between $64k–$180k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Pennsylvania right now?
There are currently 29,415 open healthcare positions in Pennsylvania listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Pennsylvania?
Companies currently hiring include UPMC, CVS Health, Temple Health – Temple University Health System, Allegheny Health Network, EmmUcare Home Health, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Pennsylvania?
Yes — 2823 of the 29415 open healthcare positions offer remote or hybrid work (964 remote, 1859 hybrid).
How do I apply for Healthcare jobs in Pennsylvania?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.