This role is for one of Weekday’s clients
Salary range: Rs 400000 - Rs 700000 (ie INR 4 - 7 LPA)

Min Experience: 3+ years
Location: Bengaluru
JobType: full-time

We are seeking an experienced and detail-oriented Enrollment Specialist with 3–6 years of experience in the US Healthcare domain. The ideal candidate will have a strong understanding of healthcare processes, member information, enrollment operations, and insurance-related workflows. This role requires excellent attention to detail, strong analytical and communication skills, and the ability to manage enrollment-related activities accurately within defined timelines.

Requirements

Key Responsibilities

• Manage and process healthcare enrollment activities in accordance with established procedures, client requirements, and regulatory guidelines.
• Review and validate member enrollment information, eligibility details, demographic data, and supporting documentation for accuracy and completeness.
• Handle member enrollment, additions, terminations, changes, and updates across healthcare plans and systems.
• Coordinate with internal teams, healthcare clients, insurance carriers, and other stakeholders to resolve enrollment-related issues.
• Identify discrepancies in enrollment and member data and take appropriate action to ensure timely resolution.
• Maintain accurate records of enrollment transactions, member information, and related documentation.
• Perform data validation and quality checks to minimize errors and ensure the accuracy of member and enrollment records.
• Investigate enrollment discrepancies, eligibility issues, missing information, and transaction errors, escalating complex cases when required.
• Follow established Standard Operating Procedures (SOPs), quality guidelines, and turnaround-time requirements.
• Support reconciliation activities by comparing enrollment data across multiple systems and identifying mismatches.
• Prepare and maintain reports related to enrollment volumes, pending cases, errors, and operational performance.
• Work closely with cross-functional teams to ensure smooth execution of healthcare enrollment processes.
• Ensure compliance with organizational policies and applicable US healthcare data-handling and privacy requirements.
• Contribute to process improvement initiatives by identifying recurring issues, operational gaps, and opportunities for greater efficiency.

Must-Have Skills

• 3–6 years of relevant experience in the US Healthcare domain.
• Strong understanding of US Healthcare processes, insurance operations, eligibility, and member data.
• Hands-on experience working with healthcare-related data, systems, or operational processes.
• Strong attention to detail with the ability to identify inconsistencies and data discrepancies.
• Good analytical and problem-solving abilities.
• Strong written and verbal communication skills.
• Ability to manage high-volume, process-driven work while maintaining accuracy and productivity.
• Proficiency in MS Excel and other commonly used business applications.
• Ability to work effectively with internal and external stakeholders.
• Strong understanding of data confidentiality and healthcare information-handling practices.

Good-to-Have Skills

• Prior experience in Enrollment or healthcare enrollment operations.
• Hands-on experience with Member Enrollment processes.
• Knowledge of health insurance plans, benefits, eligibility, and member lifecycle transactions.
• Experience working with healthcare payer, provider, or insurance administration processes.
• Familiarity with enrollment platforms, healthcare claims/administration systems, or eligibility systems.
• Exposure to enrollment reconciliation, file processing, or EDI transactions.
• Knowledge of HIPAA and other US healthcare compliance requirements.
• Experience working with international or US-based healthcare clients.

Preferred Candidate Profile

The ideal candidate is a highly organized professional who can work independently while collaborating effectively with different teams. You should be comfortable handling sensitive member information, managing multiple priorities, and working within strict turnaround times. Strong ownership, accuracy, problem-solving skills, and a customer-focused approach are essential for success in this role.