What does an enrollment specialist do?
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.
Enrollment specialist responsibilities
Here are examples of responsibilities from real enrollment specialist resumes:
- Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
- Manage customer relations with internal personnel, group administrators, brokers and members as related to HMO commercial insurance.
- Maintain records pertaining to eligibility and enrollment by managing CMS reports.
- Provide enrollment counseling to eligible recipients about Medicaid manage care and promote their voluntary enrollment into an HMO.
- Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
- Assist medical assistance consumers with choosing HMO's and PCP as well as with HMO and PCP transfers.
- Verify information, research application details, and make decisions on provider enrollment applications base on the Georgia Medicaid program guidelines.
- Document daily client and vendor activities in SalesForce.
- Perform quality review and data input of CHP applications.
- Respond to inquiries from providers regarding the NPI HIPPA mandate.
- Develop metrics and measure success in order to further penetrate the marketplace.
- Increase community awareness of health care option through ACA marketplace through educational seminars.
- Prepare return slips for incomplete FHP, CHP, Recert, and FEEA applications.
- Maintain CAQH profile for each provider, complete, review and re-attestation of information.
- Research providers using several websites including DEA, state licensing board, and NPPES.
Enrollment specialist skills and personality traits
We calculated that 20% of Enrollment Specialists are proficient in Customer Service, Patients, and Data Entry. They’re also known for soft skills such as Analytical skills, Business skills, and Communication skills.
We break down the percentage of Enrollment Specialists that have these skills listed on their resume here:
- Customer Service, 20%
Provide administrative support to the team and engaged participants in identified programs to maximize client enrollments and provide optimal customer service.
- Patients, 12%
Verified insurance coverage and eligibility while utilizing websites and consulting physician offices, insurance companies, and patients.
- Data Entry, 8%
Researched enrollment problems, corrected enrollment errors, data entry on enrollment applications, and issued membership cards and termination certificates.
- Health Insurance, 7%
Distribute information about the individual health insurance exchange, including eligibility requirements for applicable federal premium subsidies and cost-sharing assistance.
- Enrollment Process, 6%
Participated with developing admissions enrollment processes, conducted student commitment training lessons, communication coaching sessions and positive leadership training.
- Outbound Calls, 5%
Make outbound calls to targeted consumers to encourage and facilitate enrollment in health management education and wellness coaching programs.
"customer service," "patients," and "data entry" are among the most common skills that enrollment specialists use at work. You can find even more enrollment specialist responsibilities below, including:
Analytical skills. One of the key soft skills for an enrollment specialist to have is analytical skills. You can see how this relates to what enrollment specialists do because "compensation, benefits, and job analysis specialists perform data and cost analyses to evaluate their organization’s policies." Additionally, an enrollment specialist resume shows how enrollment specialists use analytical skills: "analyze pertinent facts against aca guidelines and advocate on behalf of consumers for insurance decision. "
Business skills. Many enrollment specialist duties rely on business skills. "specialists must understand basic finance and accounting," so an enrollment specialist will need this skill often in their role. This resume example is just one of many ways enrollment specialist responsibilities rely on business skills: "collaborated with small businesses to develop a strategy for aca. "
Communication skills. Another skill that relates to the job responsibilities of enrollment specialists is communication skills. This skill is critical to many everyday enrollment specialist duties, as "specialists need to provide information about compensation and benefits in a way that is understandable to employees at all levels throughout their organization." This example from a resume shows how this skill is used: "completed eligibility verification, heavy data entry, processing and team communication. "
The three companies that hire the most enrollment specialists are:
- Elevance Health
52 enrollment specialists jobs
- EmblemHealth9 enrollment specialists jobs
- Academic Partnerships
6 enrollment specialists jobs
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Compare different enrollment specialists
Enrollment specialist vs. Benefits representative
A benefits representative is responsible for facilitating and disseminating information about benefits programs and policies across all employees in the company. Benefits representatives respond to the employees' inquiries and concerns of benefits processes, update their benefits information, and resolve discrepancies and disputes. They also support the company's initiatives on developing new benefits plans, implementing campaigns, as well as writing application guides for reference. A benefits representative should have excellent communication and organizational skills as they also conduct surveys to check the efficiency and effectiveness of the benefits programs and adjusting procedures as needed.
There are some key differences in the responsibilities of each position. For example, enrollment specialist responsibilities require skills like "data entry," "medicare advantage," "financial aid," and "cms." Meanwhile a typical benefits representative has skills in areas such as "insurance coverage," "medicaid," "term disability," and "cpt." This difference in skills reveals the differences in what each career does.
Benefits representatives tend to make the most money working in the finance industry, where they earn an average salary of $41,460. In contrast, enrollment specialists make the biggest average salary, $40,066, in the health care industry.On average, benefits representatives reach similar levels of education than enrollment specialists. Benefits representatives are 0.5% less likely to earn a Master's Degree and 0.2% more likely to graduate with a Doctoral Degree.Enrollment specialist vs. Benefits advisor
A benefits advisor specializes in devising benefits programs and strategies for a workforce, ensuring they are well-compensated for their hard work. Typically, their responsibilities revolve around performing research and analysis to identify the needs of employees in a company, studying the benefit programs of competitors, and assessing the existing programs while putting the company's welfare into consideration. They must prepare reports and presentations for clients, provide cost-estimates and business plans, and evaluate risks, all while adhering to the company's policies and regulations, including its vision and mission.
In addition to the difference in salary, there are some other key differences worth noting. For example, enrollment specialist responsibilities are more likely to require skills like "customer service," "data entry," "financial aid," and "health coverage." Meanwhile, a benefits advisor has duties that require skills in areas such as "insurance benefits," "insurance products," "medicaid," and "life insurance." These differences highlight just how different the day-to-day in each role looks.
On average, benefits advisors earn a higher salary than enrollment specialists. Some industries support higher salaries in each profession. Interestingly enough, benefits advisors earn the most pay in the government industry with an average salary of $79,775. Whereas enrollment specialists have higher pay in the health care industry, with an average salary of $40,066.In general, benefits advisors achieve similar levels of education than enrollment specialists. They're 0.8% more likely to obtain a Master's Degree while being 0.2% more likely to earn a Doctoral Degree.Enrollment specialist vs. Benefits assistant
Typically working in a human resources department, a benefits assistant is in charge of performing clerical support tasks for an efficient workflow. They primarily communicate with employees to answer inquiries regarding benefits and compensation programs, assist in processing documents, and resolve issues and concerns. Their responsibilities also include conducting research and analysis, liaising with external parties such as vendors and suppliers, organizing documents, and maintaining records. Above all, it is essential to carry out duties while adhering to the company's policies and regulations.
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 specialist is likely to be skilled in "customer service," "patients," "outbound calls," and "medicare advantage," while a typical benefits assistant is skilled in "human resources," "hris," "payroll deductions," and "short-term disability."
Benefits assistants make a very good living in the government industry with an average annual salary of $45,800. On the other hand, enrollment specialists are paid the highest salary in the health care industry, with average annual pay of $40,066.When it comes to education, benefits assistants tend to earn similar degree levels compared to enrollment specialists. In fact, they're 0.1% more likely to earn a Master's Degree, and 0.1% more likely to graduate with a Doctoral Degree.Enrollment specialist vs. Workers compensation coordinator
Workers compensation coordinators work with supervisors to identify incident causes and the best corrective actions. They train coordinators and supervisors on reporting and managing workers' compensation claims. Besides coordinating EHS committee meetings and managing EHS files, workers' compensation coordinators also manage workers' programs for hearing tests, safety glasses, and safety shoes. These professionals use the company credit card or purchasing system to order safety supplies. Also, they ensure workers get the needed care by partnering with medical providers and injured employees.
Types of enrollment specialist
Updated January 8, 2025
