We’re looking for…

An Eligibility Specialist that will be able to process benefit entries and validate information. You will respond to eligibility and other enrollment related issues involving member specific information; partner directly with clients, and/or vendors, to resolve problems and achieve positive outcomes.

What’s the role?

You will be responsible for:

• Manage eligibility additions and terminations
• Changes for new and renewing clients using electronic files, paper forms and portals. 
• Ensure enrollments and changes comply with legal requirements and client specifications.
• Confirm that enrollments are activated promptly and that information is accurately and fully entered. 
• Ensure all necessary data for transfers to affiliated vendors is included.
• Provide feedback on eligibility processing during implementations and renewals to enhance processes, workflows, and products.
• Collaborate with providers, vendors, and internal departments to resolve billing or technical issues related to eligibility.
• Create and maintain system logins for Brokers and Clients.
• Respond to client inquiries and manage data transfers, adhering to department turnaround times and maintaining queue levels.
• Assist the team in reviewing system configurations and processes to ensure optimal processing.
• Audit and validate ID card processing, and generate and mail required notices for all product lines.