Senior Medicaid Enrollment Specialist

HealthEdge

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

Posted 9/23/2026full-timeRemote • United StatesSenior💰 $50,000 - $56,000 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 presenting findings effectively while mentoring junior team members and collaborating on projects.

Highest-signal resume keywords

Medicare Enrollment ProcessingCMS Transaction FilesEnrollment Reconciliation AnalysisMedicaid KnowledgeMentoring Junior Team Members

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare Advantage ProductsEnrollment VerificationCMS InterfacesData AnalysisMembership Reconciliation

Soft Skills

CollaborationStrong Work EthicAdaptabilitySelf-StarterWillingness to Learn

Industry Keywords

Enrollment and Disenrollment RequestsEligibility RequirementsClient Quality ReviewsRegulatory GuidelinesOperations Reports

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 according to regulatory and client-specific guidelines
Reconcile membership reports as required by CMS
Attend and successfully complete client- and employer-scheduled training
Mentor junior team members
Collaborate on special projects, including process documentation, training, and client quality reviews
Maintain communication with management regarding issues and concerns
Take preventive measures to ensure case accuracy and quality
Participate in management-assigned projects
Perform other duties as assigned

Requirements

What you’ll need

5+ years of professional experience processing Medicare enrollment transactions
Thorough understanding of Medicare Advantage products, CMS transaction files, and enrollment-related guidelines
Experience with CMS interfaces and systems for Medicare Advantage enrollment and billing functions
Medicaid knowledge is a plus
Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports
Ability to present findings in a structured way
High school degree required
Willingness to learn
Ability to collaborate
Strong work ethic
Ability to adapt quickly to a challenging environment
Self-starter and quick learner
Work across multiple time zones
Candidates may be required to complete a pre-employment criminal background check

Benefits

Comp & perks

Remote work environment
Client and employer training opportunities
Mentoring and professional development through special projects
Potential travel based on company needs
Reasonable accommodations for individuals with disabilities
Equal opportunity and workforce diversity commitment