Eligibility Consultant - Electronic
- Description:
- Verify enrollment status,
- make changes to member/client records,
- and address a variety of enrollment questions or concerns.
- Maintain enrollment databases and coordinate electronic transfer of eligibility data.
- Respond, research, and resolve eligibility and other enrollment related issues involving member specific information;
- work directly with clients, vendors and/or local claim operations to achieve positive service outcomes.
- Apply all appropriate considerations associated with technical requirements,
- legislative/regulatory policies,
- account structure and benefit parameters in addressing eligibility matters.
- Develop tools,
- and provide coding supplements,
- file specifications and error listing to clients/vendors.
- Act as the liaison between clients,
- vendors with defining business requirements;
- identify potential solutions and approve programming specifications required for testing.
- Ensure all transactions interface accordingly with downstream systems;
- test and validate data files for new or existing clients using system tools and track results to avoid potential problems and better address on-going service issues.
- Partner with other team functions to coordinate the release of eligibility,
- plan structure and benefit information.
- Utilize and interpret online resources to understand customer’s account structure and benefits.
- Ensure all communications with clients,
- third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
- Requirements:
- 1+ years of experience in healthcare/insurance industry customer service with the ability to communicate effectively with both internal and external customers.
- 1+ years of data entry experience.
- Experience with Microsoft Office products (e.g.; Word, Excel, PowerPoint, Outlook, Teams).
- Ability to review and understand various file layouts.
- Strong verbal and written communication skills.
- Comfortable with leading calls with various participant types.
- Knowledge of ELR file processes.
- Experience with EDI files.
- Benefits:
- Affordable medical plan options,
- a 401(k) plan (including matching company contributions),
- and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings,
- tobacco cessation and weight management programs,
- confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off,
- flexible work schedules,
- family leave,
- dependent care resources,
- colleague assistance programs,
- tuition assistance,
- retiree medical access and many other benefits depending on eligibility.
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