Senior Enrollment And Eligibility Representative

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Enrollment & Eligibility Representative (EDM) is responsible for managing complex enrollment, eligibility, and member data management activities within the US Healthcare environment. The role involves handling customer, broker, client, and internal stakeholder inquiries through email and voice channels while ensuring accuracy, compliance, and service excellence. The incumbent will independently resolve moderately complex issues, support escalations, provide guidance to team members, and contribute to process improvement initiatives.

Primary Responsibilities

• EDM Operations & Data Management
• Maintain and update member records accurately in internal systems
• Perform data verification, quality checks, and audits to ensure data integrity
• Track and document all customer interactions, resolutions, and actions taken
• Identify and report data inconsistencies, operational risks, and process gaps
• Review healthcare plans, benefits, policies, and SOPs to provide accurate resolutions
• Ensure timely completion of transactions within established Service Level Agreements (SLAs)
• Maintain quality scores and productivity targets as per business expectations
• Customer & Stakeholder Support
• Handle customer, broker, employer group, and internal partner inquiries through email and voice support
• Respond professionally to member and client concerns while maintaining high customer satisfaction
• Follow up on unresolved cases and provide regular status updates
• Act as a point of contact for escalated or complex cases
• Problem Solving & Decision Making
• Analyze complex issues and determine appropriate resolutions independently
• Apply business knowledge and established guidelines to support decision-making
• Proactively identify solutions for non-standard requests and process exceptions
• Collaborate with cross-functional teams to resolve complex operational challenges
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
  

• 2+ years of experience in Eligibility, Enrollment, EDM, Customer Service, or Healthcare Operations
• Solid knowledge of US Healthcare, Eligibility, Enrollment, and Benefits Administration
• Working knowledge of Microsoft Office Suite (Outlook, Excel, Word, PowerPoint)
• Proficiency in email handling, customer correspondence, and voice support
• Proven solid analytical and problem-solving capabilities
• Proven ability to navigate multiple systems and applications simultaneously
• Proven excellent verbal and written communication skills
• Proven solid customer-centric mindset and active listening abilities
• Proven high attention to detail and commitment to quality
• Proven ability to work independently with minimal supervision
• Proven solid ownership, accountability, and professional integrity
• Proven ability to handle work pressure
• Proven effective collaboration and teamwork skills
• Proven ability to manage competing priorities and deadlines
• Proven professional handling of escalations and challenging customer interactions