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Medicare Enrollment & Eligibility Specialist (Hybrid)
Job Number: NR29427812
Job Description
Medicare Enrollment & Eligibility Specialist (Hybrid)
Job Type: Full-Time, Direct-Hire (Permanent placement on company payroll with immediate full benefits; not a temporary job)
Location: Pittsburgh, PA 15219 (Hybrid – periodic on-site office visits depending on departmental needs)
Schedule: Monday – Friday, Day Shift (No evenings, weekends, or holidays!)
New Hire Base Pay: $20.70 per hour
Future Earning Potential: Established employees have the opportunity to earn progressive pay increases up to $30.40 per hour over time through performance, tenure, and continuous learning.
Mandatory Qualifications
- Education & Availability: High School Diploma or GED required (College degree preferred); ability to commit to full-time hours year-round.
- Customer Service & Call Center Experience: Minimum 6+ months of experience in health insurance call center support required.
- Call Center Environment: Comfortable working in a hybrid call center environment handling customer inquiries and processing electronic member transactions.
- Health Insurance & Medical Terminology: Knowledge or experience with health insurance operations, Medicare/Medicaid enrollment guidelines, and basic medical terminology required.
- Technical & Software Skills: Proficient computer/PC skills required; working knowledge of Microsoft Excel (formulas, VLOOKUPs, pivot tables, chart creation) and electronic data entry platforms preferred.
How You'll Make an Impact
- Enrollment & Disenrollment Transaction Processing: Create and maintain member eligibility records across various product lines (HMO, PPO, SNP, PDP), processing transactions in strict accordance with CMS and state regulatory guidelines.
- Regulatory Compliance & Eligibility Determination: Analyze beneficiary information and member history to make compliant eligibility determinations based on election periods, CMS (Part A/B), and state assistance rules.
- Customer & Sales Partner Support: Interact with internal teams, sales staff, and external customers to resolve enrollment inquiries, gather missing application data, and address complaints efficiently.
- Member Correspondence & Outreach: Generate and dispatch required enrollment/disenrollment letters, outreach requests, and mandatory disclosures to ensure timely, compliant communication with members.
- Data Management & Trend Identification: Perform daily clerical data entry, maintain electronic member records with high attention to detail, and identify potential compliance or operational trends to management.
What We Offer
- Predictable Work-Life Balance: Standard Monday through Friday daylight schedule with hybrid remote flexibility, no weekends, and major holidays off.
- Competitive Compensation & Growth: Set starting rate of $20.70/hr with structured career pathways into senior compliance, reporting, and operations management roles.
- Comprehensive Benefits Package: Top-tier health, dental, and vision insurance starting day one.
- Generous Retirement Match: Retirement savings with up to an 8% employer match contribution.
- Education Investment: Up to $6,000/year in tuition assistance plus tuition discounts at 30+ partner schools.
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