Enrollment Specialist I – IV

LTHC

. Perform enrollment core processing and servicing in accordance with Health Plan Operations enrollment regulations, underwriting guidelines, HIPAA, and applicable government regulations .

Posted 10/14/2026full-timeRochester • New York • United StatesJuniorMid-Level💰 $20 - $33 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in health plan operations, enrollment processing, and compliance with regulations such as HIPAA. Proficient in managing member inquiries, maintaining accurate records, and mentoring team members while meeting performance metrics.

Highest-signal resume keywords

Health Insurance Operations ExperienceEnrollment ProcessingCustomer Service SkillsMicrosoft Office Suite ProficiencyRegulatory Compliance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Enrollment ProcessingData Accuracy ReviewReport GenerationTransaction Error ValidationTest Case CreationIssue ResolutionComplex Account ProcessingMember Information ManagementPerformance Metrics AchievementRegulatory Compliance

Soft Skills

Written Communication SkillsVerbal Communication SkillsOrganizational SkillsAnalytical SkillsProblem-Solving Skills

Industry Keywords

HIPAA ComplianceHealth Plan OperationsBroker InquiriesMember ServicesEnrollment SystemsCMS ProcessingAccount Service SupportDesignated Record SetCross-Functional CollaborationPerformance Guarantee Transactions

About the role

Key responsibilities & impact

Perform enrollment core processing and servicing in accordance with Health Plan Operations enrollment regulations, underwriting guidelines, HIPAA, and applicable government regulations
Service broker, member, and group administrator inquiries through telephone, email, written inquiries, lobby walk-ins, and on-site employer group visits
Process new groups, renewals, new members, member movements, benefit changes, cancellations, and reinstatements
Maintain member and group information using multiple Health Plan, sales, marketplace, and enrollment systems
Review enrollment activity and documentation for accuracy
Research, interpret, and respond to internal and external customer, broker, consultant, business partner, and group inquiries
Run pre-built reports and validate and update transaction errors affecting eligibility interfaces
Resolve work items within department service-level agreements and complete aged and Performance Guarantee transactions according to metrics
Maintain knowledge and accuracy across inventory areas and attend required training and meetings
Meet productivity, accuracy, compliance, member touchpoint, and CMS processing-timeframe targets
Handle Designated Record Set requests and support Account Service teams at Level II
Adjust or triage subscriber enrollment changes and request additional information or verification at Level II
Cross-train and act as a resource to team members; update operating manuals and Desk Level Procedures at Level II
Staff enrollment phone lines at Level II
Mentor team members, serve as a department subject matter expert, process complex accounts, and resolve eligibility inquiries at Level III
Assist with system releases and production validation at Level III
Create test cases, test processes, establish implementation procedures, and participate in end-user testing at Level IV
Research complex and sensitive cases, identify root causes, execute resolutions, and represent the department on corporate projects and cross-functional workgroups at Level IV
Maintain member privacy, adhere to the Corporate Code of Conduct and company values, and perform other assigned functions

Requirements

What you’ll need

Completed High School Diploma or Equivalent
Minimum of two (2) years health insurance or related operations work experience preferred for Level I; higher levels require three, four, or five years preferred
Level II, III, and IV require a “Performing” or above rating for minimally 12 months
Solid/strong written and verbal communication skills
Organizational, analytical, reasoning, problem-solving, and time-management skills
Basic or strong computer proficiency, including Microsoft Office Suite; Excel for Level III
Attention to detail and accuracy
Ability to multitask and efficiently resolve customer concerns
Ability to actively listen while simultaneously taking notes and be on the phone regularly for B Version
Ability to work with minimal supervision and take accountability for issue resolution
Ability to provide mentoring and support to new hires and peers for Level III
Ability to resolve complex and escalated issues independently for Level IV
Ability to travel across the enterprise
Ability to work in a traditional office environment and a home office for business continuity
Ability to meet minimum performance metrics
Ability to orally communicate
Ability to sit at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time

Benefits

Comp & perks

Group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays
Potential remote work, determined case-by-case
Equal employment opportunity