Enrollment Representative ACA Marketplace

JOB TITLE: Enrollment Representative - Marketplace FLSA STATUS: Non-Exempt

DEPARTMENT: Enrollment

REPORTS TO: Sr. Manager, Enrollment & Member Operations 

JOB SUMMARY: Responsible for reviewing applications, verifying eligibility, entering enrollment data in plan system, reconciliation of enrollments, and assisting with member inquiries to ensure timely and accurate processing in compliance with federal and state regulations.

ESSENTIAL JOB FUNCTIONS:

1. Answers phone calls and written questions, concerns, and complaints regarding membership. 

1. Review and process enrollment applications for Marketplace members, ensuring completeness and accuracy.

1. Verify eligibility documentation and resolve discrepancies in a timely manner.

1. Enter and maintain member information in enrollment systems accurately and consistently.

1. Respond to inbound calls and inquiries related to enrollment, effective dates, and coverage status.

1. Assist members, agents, and internal departments with enrollment-related questions and issues.

1. Follow up on missing or incorrect information to ensure timely enrollment submission.

1. Track and report on enrollment activities and assist with audit preparation, as needed.

1. Collaborate with other departments (Member Service, Sales, Eligibility, Compliance) to ensure a smooth enrollment experience.

1. Maintain compliance with CMS, state Marketplace, and organizational guidelines and timelines.

1. Handle confidential member data in accordance with HIPAA and internal privacy standards.

1. Provide timely response(s) to Health Insurance Case System (HICS).  

MARGINAL JOB FUNCTIONS:

1. Takes on special projects as needed.
2. Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

 1.   Continuous Learning:

           a.  Attends staff meetings as required.

           b.  Attends appropriate training, seminars and workshops as required

      2.   Customer Focus:

           a.  Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

                and IMAS’s Standards of Conduct.

           b.  Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

      3.   Quality/Process Improvement/Safety

           a.  Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

           b.  Supports and demonstrates safety throughout all duties performed.

           c.  Follows established policies and procedures and understands and complies with all regulators

                standards set forth by governing entities.

POSITION REQUIREMENTS:

            EDUCATION/EXPERIENCE:

• High school graduate or equivalent.
• Customer service experience required
• 1+ year of customer service, data entry, healthcare, or insurance experience preferred.
• Strong attention to detail with excellent organizational and time management skills.
• Effective verbal and written communication skills.
• Basic knowledge of healthcare terminology or Marketplace/ACA processes is a plus.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook).
• Ability to work independently and as part of a team in a fast-paced environment.
• Office-based role.
• Standard business hours with occasional overtime during peak enrollment periods (e.g., Open Enrollment).
• Demonstrated knowledge in managing enrollment processes related to Individual Coverage Health Reimbursement Arrangements (ICHRA).
• Skilled in processing On-Exchange and Off-Exchange enrollments.

            LICENSURE/CERTIFICATE/TRAINING:

• n/a