Commercial Enrollment Specialist II

We are seeking a detail-oriented Commercial Enrollment Specialist II to support accurate member enrollment, billing, and eligibility administration within the healthcare industry. This fully remote, full-time position offers the opportunity to contribute to the smooth operation of Medicare Advantage enrollment processes while helping resolve complex discrepancies and system rejections. You will work with enrollment transactions, regulatory requirements, and Centers for Medicare & Medicaid Services (CMS) guidelines to maintain accurate member records and ensure operational compliance. The role also involves investigating enrollment issues, preparing case documentation for review, and reconciling membership reports. Working closely with team members and management, you will help maintain service quality, improve processes, and support operational performance. This opportunity is ideal for a collaborative professional with Medicare enrollment experience who enjoys problem-solving, continuous learning, and helping others succeed

• High school diploma or equivalent required.

• Three to five years of professional experience processing Medicare enrollment transactions.

• Thorough understanding of Medicare Advantage products, CMS transaction files, and applicable enrollment rules and guidelines.

• Experience using CMS interfaces and systems to manage Medicare Advantage enrollment and billing functions.

• Experience with enrollment reconciliation, discrepancy resolution, and maintaining accurate member information.

• Ability to analyze enrollment reconciliation data, evaluate operational performance, and prepare reports on SLAs, KPIs, and other relevant metrics.

• Strong analytical and problem-solving skills, with the ability to present findings clearly and in a structured format.

• Excellent attention to detail and a commitment to accuracy, quality, and regulatory compliance.

• Strong communication and interpersonal skills, including the ability to collaborate effectively with colleagues and management.

• Willingness to learn, adapt quickly to changing priorities, and complete required training.

• Self-motivated, proactive, and able to work effectively in a challenging, fast-paced environment.

• Strong work ethic, accountability, and a team-oriented mindset.

• Ability to work remotely across multiple time zones and remain productive during extended periods of computer-based work.

• Preferred: Experience with Medicaid enrollment and eligibility verification.