Job Description

Job Description: ACA Health Insurance Enrollment Specialist

Job Title: ACA Health Insurance Enrollment Specialist

Location: USA Health Plans – Woodstock, GA 30188

Reports to: Operations Manager

Department: Individual Benefits / Health Insurance

FLSA Status: Non-Exempt

Job Purpose

The ACA Health Insurance Enrollment Specialist is responsible for managing and supporting client enrollments through the Affordable Care Act (ACA) Marketplace. This role ensures accurate application processing, regulatory compliance, and timely resolution of Marketplace, carrier, and billing issues. The Enrollment Specialist works closely with internal teams, carriers, and government exchanges to provide a seamless client experience.

Key Responsibilities

1. Enrollment and Marketplace Management

• Process and manage ACA applications for new enrollments, renewals, and life event changes.
• Ensure accuracy, completeness, and timely submission of all Marketplace applications.
• Handle Marketplace terminations at the end of each month and communicate changes to clients as needed.

2. Marketplace Escalations and Compliance

• Manage and resolve Marketplace escalations related to eligibility, application errors, and account access.
• Maintain up-to-date knowledge of ACA regulations and eligibility requirements.
• Ensure all enrollments comply with federal regulations, including immigration-related eligibility guidelines.

3. Billing and Carrier Coordination

• Manage and resolve carrier billing issues on behalf of clients.
• Act as a liaison between clients, carriers, and Marketplace entities to ensure coverage accuracy.
• Follow up on discrepancies to prevent coverage lapses or termination.

4. Reporting and Follow-Up

• Generate and maintain reports of outstanding client actions and enrollment issues.
• Proactively follow up with clients, CMS, and state exchanges to resolve CMS Data Matching Issues (DMI).
• Track enrollment status and ensure timely resolution of all open items.

Qualifications

Education & Experience

• High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred.
• Prior experience in health insurance enrollment, specifically ACA Marketplace enrollment, required.
• Experience working with government exchanges, carriers, or enrollment platforms preferred.

Knowledge, Skills & Abilities

• Strong understanding of ACA regulations and eligibility requirements.
• Knowledge of immigration law as it relates to health insurance enrollment is a plus.
• Excellent attention to detail and organizational skills.
• Strong problem-solving, communication, and client service skills.
• Ability to work independently and manage a high-volume workload.

Compensation

• Compensation range is based on working in-office in the state in which the position resides.

Working Conditions

• Primarily office-based with potential for hybrid or remote work depending on location and business needs.
• May require extended hours during peak enrollment periods or regulatory deadlines.

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