Classicare Enrollment & Eligibility Analyst - Temporary

Temporary - AEP
Non-Exempt

GENERAL DESCRIPTION:
Responsible for the accurate and timely administration of enrollment, disenrollment, eligibility, and benefit maintenance processes in compliance with federal, state, Center for Medicare and Medicaid Services (CMS), Puerto Rico Health Services Administration (ASES), and organizational requirements. Performs analytical review of enrollment transactions, maintains data integrity across multiple systems, and supports operational areas through research, issue resolution, and process coordination.
ESSENTIAL FUNCTIONS:
•Receives, reviews, and processes enrollment, disenrollment, cancellation, reinstatement, and coverage change requests within established service level agreements (SLAs) and regulatory timeframes.
•Evaluate and analyze enrollment documentation to determine member eligibility, ensure compliance with federal, state, CMS, ASES, and organizational requirements, and establish appropriate effective dates and eligibility periods.
•Identifies applications with missing,



incomplete, or inconsistent information; initiates the required return processes and coordinates notifications to members and appropriate departments.
•Reviews and validates pending enrollment and eligibility reports to ensure timely case resolution and compliance with regulatory and departmental requirements.
•Ensures all processed transactions are supported by the appropriate member notifications and correspondence within established regulatory timeframes.
•Investigates enrollment and eligibility issues and provides recommendations for resolution to internal stakeholders, leadership, and operational departments.
•Conducts research and performs data validation activities to identify, analyze, and correct eligibility, enrollment, and demographic discrepancies.
•Responds to inquiries and service requests from internal departments through designated applications, distribution lists, and workflow ma

📌 Classicare Enrollment (San Juan)
🏢 MCS Healthcare Holdings, LLC (MCS)
📍 San Juan