Commercial Health Insurance Enrollment Specialist

Job Description

Job Description

Commercial Health Insurance Enrollment Specialist

Work Location : Pittsburgh, Pennsylvania 15219

Secure your future with a direct-hire position as an employee of the company – this is NOT a temporary role, and you'll never pay a fee for our assistance.

As a proud partner of the company, Novus Group is dedicated to helping you succeed. We provide comprehensive support, including resume fine-tuning, personalized interview coaching, compensation insights, and end-to-end navigation of the employment process, leading you directly to an offer.

Job Status : Full-time

Work Schedule : Monday through Friday, 9 : 00 am – 5 : 00 pm, overtime as necessary

Hybrid : Remote / work-from-home and a presence in the Downtown Pittsburgh office, when needed

Company Overview : The Company, a non-profit healthcare organization, is a leader in providing high-quality, compassionate care to patients. With an extensive network of hospitals, clinics, and other medical facilities, the Company is dedicated to improving the health and well-being of the communities served.

Job Summary :

As a Commercial Health Insurance Enrollment Specialist , you will play a vital role in assisting individuals and businesses in enrolling in comprehensive suite of commercial health insurance plans. Leveraging your expertise in health insurance products and regulations, you will educate clients on their options, process enrollment applications, and provide ongoing support to ensure a seamless plan implementation. Knowledge of Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID) will be crucial.

Key Responsibilities :

• Educate clients on the detailed features and benefits of commercial health insurance plans, enrollment and disenrollment requirements and processing rules based upon the product (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group, including, but not limited to, understanding and application of service areas by product
• Ability to make eligibility determinations based on CMS (Part A / Part B Eligibility), DPW (Medical Assistance Eligibility), and / or PID requirements, in accordance with the application election period guidelines. Ability to accurately identify appropriate election period based upon analysis of beneficiary / member history and regulatory guidance
• Process enrollment applications and ensure accurate data entry
• Assist clients with plan selection and provide guidance on plan utilization
• Maintain detailed records and documentation related to enrollment activities
• Stay up to date on industry regulations and changes to commercial health insurance products

Minimum Qualifications :

Compensation and Benefits :

A competitive salary is offered to new hires. Candidates will be placed within the range of $19.00 to $22.00 per hour. Applicants will be placed in the appropriate salary based on their individual experience and education. Also offered is a comprehensive benefits package including health, dental, and vision insurance, retirement plan contributions, tuition reimbursement, generous paid time off, and many more perks!

In addition to your base salary, you have the potential to significantly increase your earnings. After hire, the Company offers performance-based raises and pathways for higher pay through continuous learning and education, with the potential to reach up to $29.00 hourly in this position.

Equal Opportunity Employer :

Our organization is committed to providing equal employment opportunities to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.