Billing Membership Analyst

Eligibility & Enrollment Specialist

Location:

Akron, OH | Job Type: Full-Time, Contract |

Schedule:

Monday-Friday, 8:00 AM-5:00 PM | Weekends:
None | Work Setting:
In-Office

We are seeking an Eligibility & Enrollment Specialist to support healthcare enrollment, eligibility, billing, and claims-related operations. This position is responsible for accurately processing and reconciling transactions within claims and vendor systems while ensuring compliance with applicable regulatory and business requirements. The ideal candidate has experience with healthcare eligibility, enrollment processing, claims systems, auditing, data processing, or health plan operations and is highly detail-oriented with strong analytical and troubleshooting skills.

This is an in-office position for candidates local to the Akron/Canton area.

• Process, implement, maintain, and reconcile enrollment and eligibility transactions within claims processing and vendor systems.
• Review enrollment files and resolve system error reports accurately and within established timelines.
• Investigate transactions rejected by CMS, FFM, and other third-party vendors and take appropriate corrective action.
• Research current and proposed legislation affecting enrollment, eligibility, and premium billing functions.
• Help ensure enrollment and billing activities comply with applicable regulatory requirements.
• Analyze data from multiple sources to identify deficiencies, trends, and potential compliance risks.
• Perform quality-control audits of enrollment, reconciliation, and files exchanged with third-party vendors.
• Implement new and maintain existing enrollment and group information within claims processing systems.
• Respond to inquiries received through member/provider portals and assigned email groups.
• Conduct outreach to prospective enrollees and employer groups to confirm or clarify enrollment information when needed.
• Provide professional customer service regarding eligibility, billing, enrollment status, coordination of benefits, primary care physician changes, and address updates.
• Handle incoming calls on the Group/Broker support line and document inquiries and complaints in the appropriate workflow/document management system.
• Route service requests to the appropriate department for resolution and follow up as needed.
• Batch correspondence for scanning into the document management system.
• Assist with developing and maintaining procedures and processes designed to ensure eligibility and billing compliance.
• Maintain confidentiality of member health information and business information.
• Work independently on assigned responsibilities while collaborating with the broader team to meet department goals.

• High school diploma or equivalent.
• At least 1 year of experience in one or more of the following:
• Healthcare eligibility or enrollment processing
• Claims processing or claims operations
• Auditing records or reports
• Healthcare data processing
• Health insurance operations
• Customer service supporting healthcare, claims, or eligibility systems
• Healthcare software/application support

• Basic proficiency with Microsoft Word, Excel, and Access.
• Typing speed of at least 35 words per minute with 95% accuracy.
• Strong attention to detail and excellent proofreading skills.
• Strong analytical and problem-solving abilities.
• Ability to investigate discrepancies, troubleshoot issues, and determine appropriate resolutions.
• Professional communication skills with the ability to interact with employees, clients, providers, members, and senior leadership.
• Strong organizational and time-management skills.
• Ability to manage multiple priorities in a fast-paced, frequently changing environment.
• Ability to exercise independent judgment and make appropriate decisions.
• Ability to maintain confidentiality when handling member and business information.
• Ability to learn and maintain knowledge of changing regulatory requirements and business processes.

Candidates with experience in health insurance, Medicare Advantage, Medicaid, enrollment/eligibility, claims processing, health plan operations, premium billing, CMS, FFM, or healthcare administration are strongly encouraged to apply.

Monday-Friday. Standard hours: 8:00 AM-5:00 PM. No weekends. 100% in-office. Candidates should be local to the Akron/Canton, Ohio area.

Teams interview required. Candidates must provide their available dates and times for a Teams interview…