Eligibility Consultant – Electronic

Eligibility Consultant – Electronic

Requirements

• Excellent written and verbal communication skills which demonstrate the ability to interact courteously and effectively with both internal and external customers; skills include listening and comprehension, constructive feedback, spelling, grammar, proofreading, and telephone communication
• Demonstrated ability to creatively solve problems and create improvements
• Experience with Word, Excel, Outlook
• Data entry experience
• Understands intent/end state and operates with minimal guidance to meet that intent/end state
• Ability to manage multiple tasks and shifting priorities
• Ability to manage high work volume and oversee a variety of incoming work flows
• A team player capable of operating independently when needed
• Deliver accurate and timely results
• Follows up as needed to effectively resolve an issue

Responsibilities

• Verify enrollment status, make changes to member/client records, and address a variety of enrollment questions or concerns
• Maintain enrollment databases and coordinate transfer of eligibility data
• Utilize and interpret online resources to understand account structure and benefits, may assist with the development of such resources
• Respond, research, and resolve eligibility and other enrollment related issues involving member specific information by working directly with clients, vendors, and internal partners 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
• Act as the liaison between clients, vendors, and the IT department defining and identifying business requirements and solutions for non-standard arrangements
• 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
• Complete required set-up of policy and eligibility screens in order to activate system processing of plan benefits
• Code system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products
• Ensure all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements

Preferred Qualifications

• Previous experience is a plus