Eligibility Consultant

Eligibility Consultant

Requirements

• 1+ years of excellent customer service skills with the ability to communicate effectively with both internal and external customers.
• 1+ years of Data entry experience.
• Must be able to type at least 35WPM
• Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading, and telephone skills.
• Experience with Word and proficient in Excel.

Responsibilities

• Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns.
• Maintains enrollment databases and coordinates electronic transfer of eligibility data.
• Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
• Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
• Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors.
• Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.
• Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.
• Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information.
• Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
• Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
• Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity.
• Utilizes and interprets on line resources to understand customer’s account structure and benefits.
• May assist with the development of such resources.
• Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.
• Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.

Preferred Qualifications

• Basic knowledge of Health Insurance industry
• 6 months of more experience with QuickBase