Enrollment Representative

About the role

The Enrollment Representative supports the subscription and renewal processes for health services, ensuring accurate member data and compliance with regulatory guidelines. This role is essential to maintaining high‑quality, affordable healthcare for over one million consumers in Puerto Rico.

Key responsibilities

• Process enrollment transactions such as additions, contract creation, demographic changes, and renewals in accordance with CMS, ASES, and other agency regulations.
• Validate eligibility, maintain membership records, and ensure data accuracy across Medicare, PBM, and external provider systems.
• Analyze error reports from electronic eligibility processes, correct system entries, and coordinate benefit adjustments.
• Review and reconcile ASES files to identify eligibility losses and resolve discrepancies.
• Document all actions and resolutions in the system, adhering to regulatory and organizational policies.
• Meet established performance metrics and report any issues that may impact compliance or execution.

Required profile

• Ability to work independently on non‑routine tasks with general supervision.
• Strong judgment for analyzing and evaluating enrollment requests.
• Attention to detail and accuracy in data handling.
• Capability to communicate findings to management and collaborate with internal teams.
• Willingness to occasionally digitize relevant documentation.

Required skills