Enrollment Specialist

• Update and maintain enrollment and membership data in accordance with established policies, procedures, and regulatory requirements.
• Ensure compliance with HIPAA, COBRA, Medicare Secondary Payer (MSP) rules, CMS guidelines, and other applicable regulations.
• Monitor and process daily, weekly, and monthly enrollment transaction files received from government agencies, vendors, employers, and other partners.
• Oversee enrollment activities managed by delegated vendors, including member additions, changes, terminations, and ID card processing.
• Download, log, and maintain electronic enrollment files across multiple lines of business.
• Reconcile enrollment data, identify discrepancies, and implement corrective actions to improve data accuracy and operational performance.
• Audit enrollment records to ensure data integrity and compliance with organizational and regulatory standards.
• Collect and transmit enrollment and disenrollment data required by the Centers for Medicare & Medicaid Services (CMS).
• Ensure accurate setup and maintenance of member and group information to support claims administration and premium billing.
• Research, track, and resolve enrollment errors while identifying trends and root causes.
• Process eligibility exceptions and resolve electronic enrollment file discrepancies.
• Collaborate effectively with internal teams and external partners to support membership operations.

• High school diploma or GED equivalent.
• 1-3 years of related administrative, enrollment, insurance, customer service, healthcare operations, or data management experience; or an equivalent combination of education and experience.
• Strong attention to detail and ability to maintain accurate records.
• Ability to interpret and apply policies, procedures, and regulatory requirements.
• Strong analytical and problem-solving skills.
• Proficiency with computer systems, databases, and Microsoft Office applications.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively in a team environment.
• Commitment to maintaining confidentiality and handling sensitive information appropriately.

• Experience working in the health insurance industry.
• Knowledge of healthcare enrollment processes and eligibility management.
• Familiarity with HIPAA, COBRA, CMS regulations, Medicare enrollment, and coordination of benefits processes.
• Experience performing audits, reconciliations, and data quality assurance activities.
• Experience working with enrollment, claims, or membership administration systems.
• Understanding of federal and state healthcare regulations affecting health plan operations.

Our promise is simple. DAHL has proven year after year that we are flexible, consistent and easy to work with, which is why our clients and consultants have stayed with us, and we've continued to grow throughout the years.

Our clients know they can depend on our efforts, as we hold their priorities in high regard. We genuinely care about each and every relationship and promise to work with the utmost of respect, integrity and high energy, as we continually strive to build long-term relationships.