Eligibility Enrollment Specialist I /Grade 5

Primary Responsibilities

• Verify the loading new member or group data into the enrollment database & update the database with changes
• Responding to member eligibility or group questions & verify enrollment status
• Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes
• Inventory control of member and group transactions
• Support the Eligibility Call Center Representatives
• Ability to work with various types of member communication
• Working with our IT department to investigate and validate member eligibility
• Works directly with the Accounts Payable team to review and resolve any premium issues including outreach to members, clients and State officials as needed
• Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of customer requests.
• Participate in activities designed to improve customer satisfaction and business performance.
• Use decision-support tools to answer questions, where needed.
• Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking. Work is frequently completed without established procedures
• Maintain broad knowledge of client requirements, procedures and key contacts.
• Support projects and other departments in completing tasks/projects
• Other duties as required.

• Ability to work alternate schedules/hours based on the business’s need.
• Bachelor’s Degree preferred or High School diploma / GED (or higher) OR 10+ years of equivalent working experience
• 2+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
• Knowledge of managed care, labor and commercial carrier enrollment and eligibility procedures including hourly based eligibility and waiting periods.
• Prior experience with premium billing and reconciliation, knowledge of 834 eligibility files and transaction sets a plus.
• Fluent in COBRA, FMLA, QLE’s and other eligibility related transactions a plus
• Moderate proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications
• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
• Ability to work independently