Senior Eligibility Consultant

Senior Eligibility Consultant

Requirements

• 2+ years of experience in healthcare/insurance industry customer service with the ability to communicate effectively with both internal and external customers.
• 2+ years of data entry experience.
• Proficiency with Microsoft Office products (e.g.; Word, Excel, PowerPoint, Outlook, Teams).

Responsibilities

• 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.

Preferred Qualifications

• Previous eligibility data experience.
• Demonstrated working experience with EDI Files.
• Working knowledge of 834 file layouts.
• Demonstrated ability to creatively solve problems and create improvements.
• Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading and telephone skills.
• 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 and able to assist other team members.
• Ability to deliver accurate and timely results.