Medicare Enrollment Specialist II

HealthEdge

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

Posted 9/16/2026full-timeRemote • United StatesMid-LevelSenior💰 $40,000 - $44,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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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 in a team-oriented environment.

Highest-signal resume keywords

Medicare Enrollment ProcessingCMS Transaction FilesEnrollment Reconciliation AnalysisMedicaid Enrollment ExperienceTeam Collaboration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Enrollment ProcessingEligibility VerificationData AnalysisBilling Discrepancy ResolutionMembership Report Reconciliation

Soft Skills

Strong Work EthicAdaptabilitySelf-StarterMentoringCommunication

Tools & Technologies

CMS InterfacesEnrollment Management Systems

Industry Keywords

Medicare AdvantageCMS GuidelinesEnrollment GuidelinesClient-Specified Guidelines

About the role

Key responsibilities & impact

Prepare, process, and maintain enrollment and disenrollment requests
Verify and maintain 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
Attend and successfully complete client- and employer-scheduled trainings
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 assigned duties
Research and resolve enrollment and billing discrepancies
Build case files sent to the CMS Contractor for approval and resolution

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 is a plus
Experience with CMS interfaces and systems for managing Medicare Advantage enrollment and billing functions
Ability to analyze 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
Candidates may be required to complete a pre-employment criminal background check
Ability to work across multiple time zones in a hybrid or remote work environment
Ability to work long periods sitting and/or standing in front of a computer using video technology

Benefits

Comp & perks

Remote work environment
Training scheduled by the client and employer
Mentoring opportunities
May require travel dependent on company needs
Reasonable accommodations for individuals with disabilities
Equal opportunity employment