Enrollment Specialist I- hybrid

Enrollment Specialist

Are you someone who thrives in a detail-driven, fast-paced environment and enjoys making a real impact on people's access to healthcare? As an Enrollment Specialist, you'll play a vital role in ensuring our members are accurately and compliantly enrolled in their healthcare coverage- while being part of a collaborative, high-performing team that values precision, communication, and service.

In this role, you'll be responsible for processing and maintaining member eligibility, resolving inquiries, and supporting compliance with federal and state regulations. You'll also take ownership of HIPAA products, ensuring sensitive data is handled with care and accuracy.

We're a collaborative team working in a production-focused environment, where outbound phone calls are part of our daily rhythm. You'll often reach out directly to members by phone to gather missing or incomplete information from enrollment formshelping to move their applications forward and ensuring they receive the coverage they need.

Your work will directly support our mission to deliver exceptional service and ensure every enrollment is handled with integrity, empathy, and compliance.

What You'll Do

• Become a subject matter expert in enrollment and disenrollment rules across a variety of healthcare products (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, National Complimentary) and member types (Individual and Employer Group).
• Accurately process member transactions and generate required correspondence to ensure compliance with CMS, DPW, PID, and internal policies.
• Own the HIPAA process, ensuring accuracy and confidentiality in handling sensitive member data.
• Analyze member data to determine eligibility and appropriate election periods, applying regulatory guidance with precision.
• Partner with Sales to ensure complete and accurate application data is received and processed in a timely, compliant manner.
• Communicate directly with members via outbound phone calls to resolve missing or incomplete information on enrollment formshelping them move forward in their healthcare journey.
• Respond to inquiries from internal and external stakeholders, resolving issues with professionalism and empathy.
• Maintain confidentiality and uphold the highest standards of data integrity.
• Stay current on evolving regulations and apply new guidance to daily work.
• Support team initiatives and contribute to special projects as assigned.
• Identify trends or issues that may impact client satisfaction or regulatory compliance, and escalate as needed.
• Perform daily clerical tasks related to processing and electronic storage of member correspondence.

Qualifications:

• High school graduate or equivalent required, college degree preferred.
• Minimum of six months of customer service and/or call center experience.
• Ability to interpret and apply complex eligibility regulations as mandated by CMS, DPW, and PID.
• Demonstrates good organizational, interpersonal, leadership and communication skills.
• Attention to detail is critical to the success of this position, with skills in customer orientation.
• Will need to manage multiple tasks and projects. MS Office/PC skills required.
• Licensure, Certifications, and Clearances: Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran