Enrollment Specialist

Join Claim.MD: Simplifying Healthcare Through Innovation and Compassion

Claim.MD is a leading national electronic healthcare clearinghouse, supporting thousands of providers, payers, and software vendors across the country. Our mission is to simplify and optimize the flow of medical claims and related data, enabling healthcare organizations to operate more efficiently and deliver better patient outcomes. We are dedicated to streamlining healthcare transactions and improving operational efficiency for our users. Driven by a strong commitment to innovation and excellence, we seek individuals who are passionate about making a tangible difference in the healthcare industry.

Why You Will Love Working Here 

Collaborative Culture: Work alongside a team that values open communication, mutual respect, and shared success. 

Growth Opportunities: We invest in your professional development, offering training and pathways to advance your career. 

Flexible Work Environment: Enjoy the benefits of a work-from-home environment that supports work-life balance. 

Meaningful Impact: Contribute to a product that directly improves the efficiency of healthcare providers nationwide. 

What We Offer: 

Compensation Range - $28.85-$31.73 per hour and will be eligible to accrue overtime, where supported by business needs. Final compensation will be determined in accordance with state-specific pay transparency requirements. 

Comprehensive Benefits Package - Including health, dental, and vision coverage, as well as retirement savings plan. 

Internet Reimbursement - Up to $100 per month for high-speed internet required for the role. 

Career Growth and Development - Opportunities for skill-building, advancement, and continuous learning. 

Work-Life Balance - Flexible schedules and a supportive, collaborative work environment

Inclusive Company Culture - A commitment to diversity, equity, and inclusion in all our practices. 

Employee Wellness - Programs and resources focused on your overall well-being, including mental and physical health support. 

Work Remotely - Opportunity to work remotely from a dedicated work-from-home space. 

Paid-Time Off - Ten days of paid time off, in addition to a generous holiday schedule, to support your work-life balance and personal well-being.

About the Role 

The Enrollment Specialist is an individual contributor responsible for managing a defined portfolio of clearinghouse and payer enrollment activities that enable electronic claims, ERA, eligibility, and EFT workflows. This role applies working knowledge of payer enrollment requirements, clearinghouse standards, and internal operating practices to evaluate enrollment readiness, determine appropriate submission paths, and drive timely, compliant outcomes.

Essential Functions and Responsibilities: 

The following duties are considered essential to the successful performance of this position. These tasks are central to supporting Claim.MD’s users, maintaining compliance, and ensuring operational continuity. 

Enrollment Execution, Readiness, and Decision-Making

Manage end-to-end enrollment processing for a defined set of payers/clients, including EDI (claims, ERA, eligibility) and EFT, ensuring timely activation and documentation integrity.

Evaluate incoming enrollment requests to determine readiness (completeness, payer routing/mapping, documentation sufficiency) and manage the submission path based on payer requirements and internal operating practices.

Interpret payer portal instructions and enrollment responses to determine next steps, resolve standard discrepancies, and prevent avoidable delays.

Monitor enrollment timelines and dependencies; proactively identify enrollment risks (missing documentation, payer variances, stale confirmations) and initiate corrective actions within established guidelines.

Operational Controls, Data Integrity, and Workflow Stewardship

Perform pre-upload enrollment data validation and readiness checks (payer mapping, data accuracy, file formatting) and determine whether enrollments are ready for upload or require remediation.

Maintain accurate, audit-ready enrollment records, including confirmations, payer communications, and decision rationale for processing steps taken.

Apply internal documentation standards and quality controls to ensure enrollment actions support downstream transaction reliability and compliance expectations.

Identify recurring documentation or data quality issues and propose corrective actions or workflow clarifications to the Senior Enrollment Specialist for review.

Communication, Coordination, and Client Enablement

Serve as the primary point of coordination for routine enrollment communications with payers, clearinghouses, and internal teams; communicate status, requirements, and activation steps clearly.

Triage Enrollment Group inbox inquiries; determine appropriate response path, including resolution, request for additional documentation, or escalation.

Create and maintain support tickets for enrollment-related work, ensuring entries clearly reflect status, action taken, and next steps.

Coordinate with internal teams to ensure enrollment approvals translate into operational readiness; route confirmed connection/transmission failures to the EDI Connection Manager with complete case context.

Escalation Boundaries 

Escalate ambiguous payer guidance, repeated rejections, or non-standard enrollment requirements to the Senior Enrollment Specialist.

Escalate high-risk, precedent-setting, or cross-client systemic concerns to the Payer Relations Manager per escalation practice.

Required Experience and Competencies: 

Education 

High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred or equivalent professional experience.

Experience: 

3+ years experience in payer enrollment, clearinghouse operations, revenue cycle enrollment workflows, or equivalent healthcare administrative operations (recommended for defensibility).

Working knowledge of payer enrollment workflows and documentation standards supporting EDI (claims/ERA/eligibility) and EFT.

Demonstrated ability to evaluate enrollment readiness, identify risks, and choose appropriate resolution steps within established authority.

Strong documentation rigor, data accuracy, and operational judgment in deadline-driven workflows.

Professional communication and stakeholder coordination (payers, clearinghouse partners, internal teams).

HIPAA/privacy awareness and disciplined handling of sensitive data.

Work Environment and Expectations:

To be considered for this position, applicants must currently reside in the United States and be authorized to work on a full-time basis. Claim.MD is unable to sponsor or take over sponsorship of employment visas at this time. 

Candidates must be willing to submit to a pre-employment background check conducted in accordance with applicable federal, state, and local laws. Employment at Claim.MD is contingent upon the successful completion of this background screening process.

This is a fully remote position working Monday-Friday. 

This role operates across all U.S. time zones; however, Eastern Time (EST) availability is preferred to best support current team needs.

Employees are expected to work from a quiet, dedicated and secure home workspace (mobile or on-the-go work is not supported for this role). 

Company-issued desktop equipment will be provided.

Employees must be able to sit and use a computer and phone for extended periods. 

Employees are expected to maintain a reliable high-speed internet connection and to be available during core collaboration hours

Claim.MD is committed to creating an accessible and inclusive workplace. In accordance with the Americans with Disabilities Act (ADA), we provide reasonable accommodations to qualified individuals with disabilities. If you require accommodation during any stage of the application for the employment process, please contact Claim.MD’s HR Department. We are happy to provide support to ensure equal opportunities throughout the hiring and onboarding experience.

E-Verify Participation

Claim.MD participates in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees. As a participant in E-Verify, Claim.MD will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization.

Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Claim.MD will not use E-Verify to pre-screen job applicants or to reverify current employees and will not discriminate based on race, color, religion, sex, national origin, age, disability, or any other protected status during the E-Verify process.

For more information about E-Verify, please visit www.e-verify.gov.

Commitment to Inclusion:

At Claim.MD, we believe in a skills-first approach to recruitment and employment. This means focusing on what you can do and how you can grow, rather than traditional metrics alone. We are committed to adhering to anti-exclusion practices, removing barriers to access, and enhancing opportunities for all individuals based on merit and potential. 

Your skills, experiences, and perspective are valuable - and we want to empower you to make your mark here with us. 

Equal Employment Opportunity

Claim.MD is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees and applicants regardless of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected status.

Interested in applying? Submit your application. We look forward to welcoming you!