Eligibility Consultant – Paper Operations
Job Description:
• Verify member enrollment status
• Make changes to member – demographics, effective and term dates
• Addresses a variety of enrollment questions or concerns from the health plan / state
• Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
• Manually update urgent request received via email from the health plan / state
• Work claim inquiries (H03s)
• Manually enter temp newborns
• Review and manually update all reconciliation reports received from Finance
• Responds, researches, and resolves eligibility related issues involving member specific information
• Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
• Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
• Partners with other team functions to coordinate the release of eligibility and benefit plan information.
Requirements:
• Customer Service experience.
• Attention to detail and accuracy.
• Problem solving skills.
• Strong organization skills.
• Understands the impact of work to other teams and downstream support areas.
• Ability to analyze and research data to make appropriate corrections as necessary.
• Strong verbal and written communication skills.
• Workplace flexibility - ability to adapt to change.
• Knowledge of Health Care and/or MCO’s (preferred).
• Knowledge of Enrollment (preferred).
• Knowledge Medicaid and/or Medicare (preferred).
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• 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.
Apply Now
Apply Now
• Verify member enrollment status
• Make changes to member – demographics, effective and term dates
• Addresses a variety of enrollment questions or concerns from the health plan / state
• Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
• Manually update urgent request received via email from the health plan / state
• Work claim inquiries (H03s)
• Manually enter temp newborns
• Review and manually update all reconciliation reports received from Finance
• Responds, researches, and resolves eligibility related issues involving member specific information
• Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
• Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
• Partners with other team functions to coordinate the release of eligibility and benefit plan information.
Requirements:
• Customer Service experience.
• Attention to detail and accuracy.
• Problem solving skills.
• Strong organization skills.
• Understands the impact of work to other teams and downstream support areas.
• Ability to analyze and research data to make appropriate corrections as necessary.
• Strong verbal and written communication skills.
• Workplace flexibility - ability to adapt to change.
• Knowledge of Health Care and/or MCO’s (preferred).
• Knowledge of Enrollment (preferred).
• Knowledge Medicaid and/or Medicare (preferred).
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• 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.
Apply Now
Apply Now