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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