Enrollment Specialist

Job Title: Enrollment Specialist
Work Location: In-person, Tampa, FL

Company Overview

CSTS Customer Service and Technology Solutions, LLC is a leading third-party administrator dedicated to transforming the healthcare experience. We specialize in managing the administrative and operational tasks for Medicare Advantage insurance health plans, ensuring compliance with federal regulations while delivering exceptional service to our partners.

If you are passionate about delivering exceptional customer experiences and want to be part of a team that is transforming healthcare, we invite you to apply today!

Position Summary
The Enrollment Specialist is responsible for enrollment of Medicare beneficiaries, prepares, processes, and maintains new member applications, re-enrolls, dis-enrolls, LEP and plan changes or group enrollments and eligibility calculations as stipulated in the CMS guidelines including a variety of clerical duties involving typing, filing, records, and reports maintenance, researching, documenting, evaluating, and executing all requested member enrollment transactions. Maintains strict member and company policy confidentiality.

Essential Duties and Responsibilities

• Data Enters applications, cancellations, and disenrollments.
• Performs the daily and monthly TRR and coordinates with Analyst and Manager.
• Responsible for reconciling, maintaining, and tracking all new applications in the receiving log and doing a reconciliation audit of all received applications versus applications in Log for processing. Send daily report to enrollment manager.
• Receives, stamps, and logs all correspondence received in the team in a timely and accurate manner according to CMS regulations and CSTS policy and procedures.
• Researches all enrollment applications for completeness using all CMS regulations and time frames. Identifies and process all incomplete and complete enrollment elections in compliance with CMS regulations.
• Acts as liaison between enrollment and sales by reporting any issues that will cause a delay in processing enrollment applications.
• Evaluate prospective members for Medicaid eligibility as needed. Monitor and process Medicaid recertification for current enrollees.
• Responds to member eligibility or group questions and verifies enrollment status. Answers telephone calls and transfers to appropriate staff member.
• Updates demographic data, benefits, and other fields in the Enrollment systems based on reports or other documents received and assigned by the Leadership direction.
• Process the MultiCounty report and provide outcome to management.
• Perform daily audits of scrubbing, data entry, and receiving processes.
• Works monthly reconciliation reports assigned by Leadership directions.
• Operates computers programmed with Enrollment software to record, store, and analyze information.

Other Duties
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Other duties may be assigned by leadership as business needs evolve.

Supervisory Responsibility
This job has no supervisory responsibilities.

Required Education and Experience

• High school diploma or equivalent plus two to three years’ previous experience highly desired.
• Experience in a managed care environment with members and provider information systems preferred.
• Experience working CMS monthly reconciliation reports is required.
• Expert in Microsoft Office applications.
• Experience in CMS systems.

Equal Employment Opportunity

We are committed to creating an inclusive workplace where all employees are valued and respected. We are proud to be an Equal Opportunity Employer and do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable law. We encourage candidates from all backgrounds to apply.

Job Type: Full-time

Pay: $19.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• This position is based in the Tampa, FL area and requires working in the office. Are you willing and able to work on-site?

Experience:

• Medicare Advantage Health Plan: 1 year (Required)
• Medicare Enrollment/Disenrollment processing: 1 year (Required)

Work Location: In person

Salary : $19 - $23