What does an enrollment representative do?
An enrollment representative directly communicates with clients when it comes to enrollment programs. Although their duties vary on their place or industry of employment, it typically includes helping enrollees understand the program requirements and rules, reaching out to enrollees to provide updates, gathering and processing applications, answering inquiries, and collecting payments when necessary. They also perform clerical tasks such as preparing and processing documents, updating databases, and maintaining records. Moreover, an enrollment representative must maintain an active communication line with staff for a smooth and efficient workflow.
Enrollment representative responsibilities
Here are examples of responsibilities from real enrollment representative resumes:
- Achieve excellent customer satisfaction ratings as documented by CIGNA surveys.
- Audit all tickets for proper labs, correct ICD-9 coding and CPT coding.
- Learned ICD-9 codes and medical billing to insure prompt and accurate processing of claims.
- Resolve claims by verifying CPT and ICD-9 coding and the expected reimbursement per contractual agreements with varying insurance providers.
- Proofread any errors than may occur, fax, file, track all PCP forms
- Adhere to all key audit controls and comply with all establish standards associate with HIPAA, SOX and SAS70.
- Process PPO group and payer applications and changes while maintaining department standards for quality, productivity and customer service.
- Document daily activities in SalesForce using standard processes.
- Document grievances, organization determination, and appeals.
- Respond timely to Medicare appeals from providers and beneficiaries.
- Communicate and coordinate EDI issues with implementation and client services departments.
- Enter members demographics into database, verify PCP information and benefit eligibility.
- Used escalation procedures to communicate any implementation project or EDI processing delays.
- Bill Medicare Medicaid & HMO electronically follow up on oustanding account receivables.
- Maintain communications with clients to request need applicant information according to HIPAA guidelines.
Enrollment representative skills and personality traits
We calculated that 22% of Enrollment Representatives are proficient in Home Health, Customer Service, and Data Entry. They’re also known for soft skills such as Computer skills, Interpersonal skills, and Listening skills.
We break down the percentage of Enrollment Representatives that have these skills listed on their resume here:
- Home Health, 22%
Processed Medicare applications for hospitals, skilled nursing facilities, hospices and home health agencies.
- Customer Service, 18%
Utilized critical thinking and problem-solving skills to address and resolve customer issues and ensure a positive experience with exceptional customer service.
- Data Entry, 10%
Updated personal information in the system; performed data entry according to aggressive productivity standards.
- Patients, 6%
Performed insurance/billing clerical duties, including reviewing and verifying patients account information against insurance program specifications.
- CMS, 4%
Improved timeliness standards within the CMS established protocol and procedures resulting in the exceeding of departmental standard for data accuracy.
- Enrollment Process, 4%
Collected proper documents to complete enrollment process Scanned and enter necessary info for state and federal completion of application.
"home health," "customer service," and "data entry" are among the most common skills that enrollment representatives use at work. You can find even more enrollment representative responsibilities below, including:
Interpersonal skills. Another soft skill that's essential for fulfilling enrollment representative duties is interpersonal skills. The role rewards competence in this skill because "representatives should be able to create positive interactions with customers." According to an enrollment representative resume, here's how enrollment representatives can utilize interpersonal skills in their job responsibilities: "performed multitasking and interpersonal skills by handling high call volumes, as well as conducting data entry. "
Listening skills. Another skill that relates to the job responsibilities of enrollment representatives is listening skills. This skill is critical to many everyday enrollment representative duties, as "representatives must listen carefully to ensure that they understand customers in order to assist them." This example from a resume shows how this skill is used: "communicated finance options and aided in the application process of federal financial aid programs, scholarships and alternate funding options. "
Patience. A big part of what enrollment representatives do relies on "patience." You can see how essential it is to enrollment representative responsibilities because "representatives should be patient and polite, especially when interacting with dissatisfied customers." Here's an example of how this skill is used from a resume that represents typical enrollment representative tasks: "resolve all customer issues, demonstrating patience and courtesy in any circumstances. "
Problem-solving skills. Another crucial skill for an enrollment representative to carry out their responsibilities is "problem-solving skills." A big part of what enrollment representatives relies on this skill, since "representatives must determine solutions to customers’ problems." How this skill relates to enrollment representative duties can be seen in an example from an enrollment representative resume snippet: "identified potential bottlenecks within the student enrollment process and initiate steps toward resolution"
Communication skills. Another skill commonly found on enrollment representative job descriptions is "communication skills." It can come up quite often in enrollment representative duties, since "customer service representatives must be able to provide clear information in writing, by phone, or in person." Here's an example from a resume of how this skill fits into day-to-day enrollment representative responsibilities: "create a professional rapport with each student while engaging in effective communication via telephone, and email appointments. "
The three companies that hire the most enrollment representatives are:
- Molina Healthcare266 enrollment representatives jobs
- Change Healthcare49 enrollment representatives jobs
- Elevance Health
34 enrollment representatives jobs
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Compare different enrollment representatives
Enrollment representative vs. Associate customer service representative
An associate customer service representative is responsible for providing high customer service by assisting customers on their inquiries and concerns, as well as resolving and escalating high-level complaints to the supervisor or tenured customer service representative. Associate customer service representatives also process orders and payments from the customers, replacing defective items, and issuing refunds as needed. They must have excellent communication and organizational skills, especially on handling data processing procedures to the database for reference to customer concerns.
These skill sets are where the common ground ends though. The responsibilities of an enrollment representative are more likely to require skills like "home health," "data entry," "cms," and "enrollment process." On the other hand, a job as an associate customer service representative requires skills like "customer complaints," "customer satisfaction," "sales floor," and "customer calls." As you can see, what employees do in each career varies considerably.
Associate customer service representatives really shine in the finance industry with an average salary of $37,473. Comparatively, enrollment representatives tend to make the most money in the non profits industry with an average salary of $35,222.The education levels that associate customer service representatives earn slightly differ from enrollment representatives. In particular, associate customer service representatives are 7.1% less likely to graduate with a Master's Degree than an enrollment representative. Additionally, they're 0.1% less likely to earn a Doctoral Degree.Enrollment representative vs. Enrollment specialist
Typically the responsibilities of an enrollment specialist revolve around gathering information from clients, explaining policies and regulations, obtaining requirements, and determining whether the clients are eligible for the program or service. They also process and verify applications, maintain records and database of information, and handle any issues and concerns. There are also instances where they must manage billing and even process payments. Furthermore, an enrollment specialist must adhere to the company's policies and standards while reaching out to clients.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that enrollment representative responsibilities requires skills like "home health," "transactional data," "excellent interpersonal," and "member correspondence." But an enrollment specialist might use other skills in their typical duties, such as, "health coverage," "powerpoint," "hr," and "marketplace."
Enrollment specialists earn a higher average salary than enrollment representatives. But enrollment specialists earn the highest pay in the health care industry, with an average salary of $40,066. Additionally, enrollment representatives earn the highest salaries in the non profits with average pay of $35,222 annually.enrollment specialists earn similar levels of education than enrollment representatives in general. They're 3.0% less likely to graduate with a Master's Degree and 0.1% more likely to earn a Doctoral Degree.Enrollment representative vs. Claims service representative
Claims service representatives evaluate customer insurance claims. Their tasks in this career include interviewing witnesses or customers and visiting accident sites to assess the scope of the claim. Also, they determine whether it is worth arranging a settlement and make sure all settlement claims are managed quickly. In addition to evaluating accidents and claims, they renew customer policies based on their history. Qualifications for the job include a firm knowledge of overall company policy, computer literacy, and excellent customer service.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, an enrollment representative is likely to be skilled in "home health," "data entry," "patients," and "cms," while a typical claims service representative is skilled in "insurance claims," "policy coverage," "phone calls," and "claims process."
Claims service representatives earn the highest salary when working in the government industry, where they receive an average salary of $38,986. Comparatively, enrollment representatives have the highest earning potential in the non profits industry, with an average salary of $35,222.Most claims service representatives achieve a lower degree level compared to enrollment representatives. For example, they're 5.6% less likely to graduate with a Master's Degree, and 0.1% less likely to earn a Doctoral Degree.Enrollment representative vs. Provider services representative
A provider services representative is responsible for supporting, developing, and maintaining service relationships with involved participants, including providers, physicians, and administrators. Your duties typically include responding to direct and electronic questions from clients about rates, policies, referrals, and eligibility, handling telephone calls for the provider and member inquiries, and resolving complaints by the member and member representative. In addition, you will be assisting in collecting supporting data and documentation about the member's care. You are also expected to conduct research to be able to provide a well-informed answer to members' inquiries.
Types of enrollment representative
Updated January 8, 2025
