Commercial Enrollment Specialist II

HealthEdge

. Prepare, process, and maintain enrollment and disenrollment requests .

Posted 10/8/2026full-timeRemote • United StatesMid-LevelSenior💰 $40,000 - $44,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in processing Medicare enrollment transactions and a thorough understanding of Medicare Advantage products and CMS guidelines. Capable of analyzing enrollment data and collaborating effectively with team members while maintaining high standards of accuracy and quality.

Highest-signal resume keywords

Medicare Enrollment ProcessingCMS Transaction FilesEnrollment Reconciliation AnalysisMedicaid Enrollment ExperienceTeam Collaboration

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Enrollment ProcessingEligibility VerificationData AnalysisMembership ReconciliationCMS InterfacesMedicare Advantage ProductsRegulatory ComplianceTransaction Processing

Soft Skills

Strong Work EthicAdaptabilityTeam CollaborationMentoringCommunication

Certifications & Qualifications

High School Degree

Industry Keywords

MedicareCMSEnrollment GuidelinesBilling FunctionsKPI Reporting

About the role

Key responsibilities & impact

Prepare, process, and maintain enrollment and disenrollment requests
Verify and maintain all applicable eligibility requirements
Review and process CMS transactions
Review Medicaid eligibility and complete verification processes
Resolve enrollment system rejections based on regulatory and client-specified guidelines
Reconcile membership reports as required by CMS
Mentor junior team members
Collaborate on special projects, including process documentation, training, and quality reviews
Communicate with management about issues and concerns and take preventive measures to ensure case accuracy and quality
Participate in management-assigned projects
Perform other duties as assigned
Report to the Enrollment Manager

Requirements

What you’ll need

High school degree required
3-5 years of professional experience in processing Medicare enrollment transactions
Thorough understanding of Medicare Advantage products, CMS transaction files, and corresponding enrollment-related guidelines
Medicaid enrollment experience a plus
Experience with CMS interfaces and systems for managing Medicare Advantage enrollment and billing functions
Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
Willingness to learn
Team collaborator
Strong work ethic
Ability to adapt quickly to a challenging environment
Self-starter and quick learner
Ability to collaborate
Must successfully complete client- and employer-scheduled training
Candidates may be required to undergo a pre-employment criminal background check

Benefits

Comp & perks

Remote work environment
Hybrid or remote work environment
May require travel dependent on company needs
Reasonable accommodations for individuals with disabilities
Equal opportunity employer committed to workforce diversity