Walk-in || Senior Enrollment and Eligibility Representative

Job Summary:

The Senior Enrollment & Eligibility Representative (EDM) is responsible for managing complex enrollment, eligibility, and member data management activities within the US Healthcare environment. The role involves handling customer, broker, client, and internal stakeholder inquiries through email and voice channels while ensuring accuracy, compliance, and service excellence. The incumbent will independently resolve moderately complex issues, support escalations, provide guidance to team members, and contribute to process improvement initiatives.

Key Roles & Responsibilities:

EDM Operations & Data Management

• Maintain and update member records accurately in internal systems
• Perform data verification, quality checks, and audits to ensure data integrity
• Track and document all customer interactions, resolutions, and actions taken
• Identify and report data inconsistencies, operational risks, and process gaps
• Review healthcare plans, benefits, policies, and SOPs to provide accurate resolutions
• Ensure timely completion of transactions within established Service Level Agreements (SLAs)
• Maintain quality scores and productivity targets as per business expectations

Customer & Stakeholder Support

• Handle customer, broker, employer group, and internal partner inquiries through email and voice support
• Respond professionally to member and client concerns while maintaining high customer satisfaction
• Follow up on unresolved cases and provide regular status updates
• Act as a point of contact for escalated or complex cases

Problem Solving & Decision Making

• Analyze complex issues and determine appropriate resolutions independently
• Apply business knowledge and established guidelines to support decision-making
• Proactively identify solutions for non-standard requests and process exceptions
• Collaborate with cross-functional teams to resolve complex operational challenges

Required Skills

• 24+ years of experience in Eligibility, Enrollment, EDM, Customer Service, or Healthcare Operations
• Strong knowledge of US Healthcare, Eligibility, Enrollment, and Benefits Administration
• Proficiency in email handling, customer correspondence, and voice support
• Working knowledge of Microsoft Office Suite (Outlook, Excel, Word, PowerPoint)
• Strong analytical and problem-solving capabilities
• Ability to navigate multiple systems and applications simultaneously
• Excellent verbal and written communication skills
• Strong customer-centric mindset and active listening abilities
• High attention to detail and commitment to quality
• Ability to work independently with minimal supervision
• Strong ownership, accountability, and professional integrity
• Ability to handle work pressure
• Effective collaboration and teamwork skills
• Ability to manage competing priorities and deadlines
• Professional handling of escalations and challenging customer interactions