Customer Service Representative I – Enrollment

Geisinger

. Resolve and reconcile enrollment reports and related eligibility issues according to policies, procedures, and state coverage and eligibility guidelines .

Posted 9/21/2026full-timePennsylvania • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in resolving enrollment issues, interpreting eligibility guidelines, and providing customer service support. Proficient in managing membership data and ensuring compliance with policies and procedures.

Highest-signal resume keywords

Customer Service ExperienceEnrollment Report ReconciliationEligibility DeterminationClaims ResolutionCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Membership Data ManagementData Extract ReportingPolicy InterpretationAudit ComplianceBenefits Analysis

Soft Skills

Communication SkillsCustomer Retention Skills

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Enrollment ReportsEligibility GuidelinesClaims IssuesEmployer GroupsCross-Training

About the role

Key responsibilities & impact

Resolve and reconcile enrollment reports and related eligibility issues according to policies, procedures, and state coverage and eligibility guidelines
Initiate communication and literature for newly enrolled Health Plan members, dependents, and employer groups
Interpret and apply rules and regulations in contractual agreements with employer groups and vendors
Perform membership data extract reports for employer group audit and compliance purposes
Update, approve, and interpret membership data and workflow in employer group modules
Determine member eligibility and process terminations and disenrollments
Prepare and disseminate letter communications regarding enrollment activity
Determine whether services are covered benefits based on line of business and product design
Review suspended claims and resolve issues using applicable policies, procedures, and benefits
Support member and provider services staff with claims resolution policies and procedures
Provide daily support and advice regarding claims issues
Research provider claim issues and identify criteria for payment reconsideration
Participate in cross-training and process improvement within the Customer Service team

Requirements

What you’ll need

High School Diploma or Equivalent (GED) (Required)
Minimum of 1 year of customer service experience (Required)
Communication skills
Customer Retentions skills
Customer Service skills
Ability to comply with organization policies and procedures
Ability to work days and 40 scheduled hours per week

Benefits

Comp & perks

Healthcare benefits for full-time and part-time positions from day one
Vision coverage
Dental coverage
Domestic partner benefits
Collaborative, cooperative and collegial work atmosphere