Job Title: Membership Specialist
Contract Duration: 4 months, possible extension
Work Arrangement: Remote
Summary
The Membership Specialist is responsible for supporting enrollment operations within a Medicare Advantage environment while ensuring compliance, accuracy, and operational excellence. This role serves as a subject matter expert for membership and enrollment processes, conducts audits to identify discrepancies and improvement opportunities, and provides coaching and guidance to team members to support performance and quality standards. The ideal candidate is highly detail-oriented, possesses strong analytical skills, and has experience working within regulated healthcare environments.
Key Responsibilities
- Support day-to-day membership and enrollment operations for Medicare Advantage plans.
- Review, validate, and process member enrollment transactions while ensuring compliance with CMS and organizational guidelines.
- Conduct audits of enrollment and membership processes to identify trends, errors, and areas for operational improvement.
- Analyze workflow performance and recommend process enhancements that improve efficiency, accuracy, and service delivery.
- Monitor adherence to policies, procedures, and regulatory requirements.
- Provide coaching, training, and ongoing feedback to team members to improve quality, productivity, and compliance performance.
- Collaborate with internal stakeholders to resolve enrollment issues and support operational initiatives.
- Assist with corrective action plans and process improvement efforts when operational gaps are identified.
- Maintain accurate records and documentation in accordance with departmental and regulatory standards.
- Participate in special projects and continuous improvement initiatives as assigned.
Required Qualifications
- High school diploma or GED required; associate’s or bachelor’s degree preferred.
- Experience supporting enrollment operations within a Medicare Advantage environment.
- Experience auditing processes and identifying operational improvement opportunities.
- Demonstrated ability to coach, mentor, and develop team members.
- Strong knowledge of compliance, quality, and accuracy standards within a regulated healthcare environment.
- Excellent analytical, problem-solving, and organizational skills.
- Strong written and verbal communication skills.
- Proficiency with Microsoft Office applications, including Excel.
Preferred Qualifications
- Knowledge of CMS regulations and Medicare Advantage enrollment requirements.
- Experience working with membership, enrollment, or healthcare administration systems.
- Experience participating in process improvement or quality assurance initiatives.
- Familiarity with health insurance operations and member services environments.