Enrollment Specialist 1/2/3/4
$20 - $33.03
Junior, Mid, Senior
Rochester, NY, USA+4 moreMore locations: De Witt, NY, USA | Albany, NY, USA | Binghamton, NY, USA | Buffalo, NY, USA
In PersonTravel across the enterprise is required. Remote work may be available case by case.
Insurance
About the job
Requirements
- Level I requires a completed high school diploma or equivalent.
- Level I requires a minimum of two years of health insurance or related operations work experience, preferred, and proven ability to perform the role's requirements and responsibilities.
- Level I requires solid written and verbal communication skills, organizational, analytical, and time-management skills, basic computer proficiency including Microsoft Office Suite, and attention to detail and accuracy.
- Level I requires the ability to multitask to resolve customer concerns by understanding customer needs, navigating computer screens, and typing inquiry documentation.
- For the B version, the employee must actively listen to customers while taking notes and be available on the phone regularly.
- Level II requires a minimum of three years of health insurance or related operations work experience, preferred, proven role capability, and a performance rating of Performing or above for at least 12 months.
- Level II requires organizational, reasoning, and problem-solving skills, accountability and ownership of issues and resolutions with minimal supervision, global thinking, and initiative to identify team opportunities.
- Level III requires a minimum of four years of health insurance or related operations work experience, preferred, proven role capability, and a performance rating of Performing or above for at least 12 months.
- Level III requires strong written and verbal communication skills and strong computer proficiency, including Microsoft Excel.
- Level III requires the ability to provide mentoring and support to new hires and peers and assist with management-assigned tasks requiring advanced problem-solving.
- For the B version, the employee must actively listen to customers while taking notes and be available on the phone regularly.
- Level IV requires a minimum of five years of health insurance or related operations work experience, preferred, proven role capability, and a performance rating of Performing or above for at least 12 months.
- Level IV requires self-sufficiency in resolving complex and escalated issues and the ability to lead management-assigned tasks requiring advanced problem-solving across multiple areas.
- For the B version, the employee must actively listen to customers while taking notes and be available on the phone regularly.
- Physical requirements include working in a traditional office environment under fluorescent lighting; arriving on time as scheduled; meeting minimum performance metrics; oral communication; sitting at a desk while viewing a computer and using a keyboard and mouse for three or more hours at a time; traveling across the enterprise; and working in a home office for continuous periods for business continuity.
Responsibilities
- Perform enrollment core processing and servicing in accordance with health plan enrollment regulations, underwriting guidelines, applicable government regulations, and HIPAA requirements after completing training.
- Provide prompt, accurate, and efficient service for broker, member, and group administrator inquiries through telephone, email, written inquiries, lobby walk-ins, and on-site employer-group visits.
- For Level I, handle government program and small, mid-sized, and large employer group subscriber enrollment operations.
- Maintain communication with Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, Customer Care, and external customers, groups, or brokers as needed.
- Enroll new groups, renewals, new members, and member movements.
- Prepare, process, install, and maintain member enrollments and member information across health plan, sales, marketplace, and enrollment systems, including benefit changes, renewals, cancellations, and reinstatements; review enrollment activity and documents for accuracy against applicable regulations and guidelines.
- Research, interpret, and respond to internal and external inquiries about products, services, and policies in accordance with regulations, corporate policy, association guidelines, and productivity measures; run pre-built reports.
- Review, validate, and update transaction errors from member-level electronic and paper sources that affect eligibility interfaces.
- Identify and respond to internal and external work items and meet departmental service-level agreements.
- Prioritize aged and Performance Guarantee transactions and complete them on time according to established metrics.
- Maintain knowledge and accuracy in entry-level processing across at least three inventory areas.
- Attend necessary training to support the role and share knowledge with the team; attend meetings as needed and share information with the team.
- Meet productivity and accuracy metrics, compliance and member-touchpoint measures, and CMS processing timeframes while providing quality service to internal and external customers.
- Maintain a general understanding of cross-functional enrollment processes and operating systems.
- Protect member privacy in accordance with corporate privacy policies and procedures and adhere to the Corporate Code of Conduct and Lifetime Way values.
- Maintain regular and reliable attendance and perform other functions assigned by management.
- For Level II, process and maintain group enrollments, including group setup, benefit changes, renewals, cancellations, and reinstatements; review group enrollment activity and documents for accuracy.
- For Level II, handle Designated Record Set requests and serve as a point person for the Account Service team when normal channels do not provide needed information.
- For Level II, adjust or triage enrollment adjustments for subscriber additions, deletions, and changes, and initiate correspondence requesting additional information or verification.
- For Level II, support or cross-train team members, maintain knowledge and accuracy across at least half of inventory areas, and develop in-depth knowledge of cross-functional enrollment processes and operating systems.
- For Level II, identify issues, patterns, and trends affecting compliance, customer satisfaction, and system performance; recommend and initiate improvements based on process review.
- For Level II, assist in creating or updating operating manuals and Desk Level Procedures and staff enrollment phone lines to resolve inbound inquiries promptly and accurately.
- For Level III, demonstrate proficiency across most inventory areas and operating systems, with expertise in specific job functions; mentor and collaborate with teammates by sharing tools and best practices and serving as a role model.
- For Level III, serve as a departmental subject matter expert, cross-train on tasks across lines of business, and identify and remove barriers to productivity, quality, cost effectiveness, timeliness, and customer satisfaction.
- For Level III, process enrollment activities for complex accounts, reprioritize daily assignments for urgent or complex cases, and research, respond to, and resolve eligibility inquiries with internal and external customers through multiple communication methods.
- For Level III, assist with system releases and production validation as needed.
- For Level IV, create test cases, test processes, document and establish procedures for implementing new products and work efforts, and participate in end-user testing as requested.
- For Level IV, research complex cases to identify root causes and recommend and execute resolutions through completion.
- For Level IV, manage complex or sensitive cases, including key brokers, accounts, special arrangements, government programs, and enrollment-resolution cases requiring deep research.
- For Level IV, represent the department on corporate projects and cross-functional work groups, serving as a subject matter expert and advising project teams and leadership on impacts of requirements to productivity and quality.
About the company
Excellus BCBS is a nonprofit health plan serving upstate New York, from Utica through Rochester, as part of the national Blue Cross Blue Shield network. It offers individual, family, Medicare, Medicaid, and employer health plans, plus virtual care, wellness programs, and Social Care Networks addressing housing, food, and transportation needs. What sets Excellus apart is pairing local, community support with a nationwide Blue provider network. The goal is to deliver affordable, accessible care that helps members and communities thrive.
Company Size
N/A
Company Stage
N/A
Total Funding
N/A
Headquarters
Rochester, New York
Founded
1932
Simplify's Take
What believers are saying
- Excellus reported 81% provider satisfaction in January 2026, signaling strong network relationships.
- 2026 Medicare Advantage benefits add $0 preventive care, dental, fitness, and telehealth.
- Excellus extended Foodlink support three years, reinforcing community reputation and member goodwill.
What critics are saying
- Excellus faces a racial discrimination trial after Judge Brindisi rejected summary judgment in July 2026.
- DFS rate filings seek 17.0% small-group and 17.2% individual increases for 2027.
- Intraoperative Neurology Services sued in February 2026 after Excellus allegedly failed payment awards.
What makes Excellus BCBS unique
- Excellus is a nonprofit, local upstate New York carrier with deep regional employer trust.
- Its 31-county Medicare Advantage network bundles dental, vision, hearing, telehealth, and transportation.
- Community Investments funds targeted health equity programs, giving Excellus visible civic embeddedness.
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Benefits
- Health Insurance
- Dental Insurance
- Wellness Program
- Paid Holidays
- Remote Work Options
- 401(k) Retirement Plan