Enrollment Specialist I

Detego Health is seeking a frontline enrollment resource to serve as the primary point of contact for prospective and newly enrolled members. This role supports members through the enrollment process by answering questions about status, activation timelines, eligibility, required documents, plan details, portal access, ID cards, renewals, and initial benefit education.

Working within approved scripts, workflows, and service standards, the Enrollment Specialist I resolves routine questions, documents every interaction, and routes claims or active-service needs to the appropriate internal team. The goal is to make enrollment simple, understandable, and successful for every member.

Key responsibilities

• Serve as the first point of contact for enrollment questions by phone, email, and other approved channels
• Authenticate members and protect confidential information in accordance with HIPAA, privacy, and company requirements
• Explain enrollment status, eligibility, effective dates, activation timelines, premiums, and required documents using approved resources
• Provide plan comparison support and initial benefit education, including deductibles, copays, coinsurance, out-of-pocket maximums, provider networks, and pharmacy benefits
• Help members with portal registration, digital access, and ID card expectations before and shortly after activation
• Research routine enrollment, activation, and eligibility questions in HealthVue, E123, and other approved systems
• Accurately document all contacts, actions, status updates, and follow-ups in required systems
• Use approved call reasons, disposition codes, work queues, and routing procedures
• Follow up with internal teams or distributors when enrollment information, documents, or eligibility records are missing or delayed
• Transfer claims, EOB, prior authorization, appeal, provider dispute, complaint, and active-service questions to the appropriate team using the approved handoff process
• Escalate complex, sensitive, unresolved, or exception-based matters to the Enrollment Team Lead or designated operational resource
• Participate in training, coaching, team meetings, quality reviews, and continuous improvement
• Perform other related duties as assigned