Eligibility Consultant - Electronic

Description: • 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. Requirements: • 1+ years of experience in healthcare/insurance industry customer service with the ability to communicate effectively with both internal and external customers. • 1+ years of data entry experience. • Experience with Microsoft Office products (e.g.; Word, Excel, PowerPoint, Outlook, Teams). • Ability to review and understand various file layouts. • Strong verbal and written communication skills. • Comfortable with leading calls with various participant types. • Knowledge of ELR file processes. • Experience with EDI files. Benefits: • Affordable medical plan options, • a 401(k) plan (including matching company contributions), • and an employee stock purchase plan. • No-cost programs for all colleagues including wellness screenings, • tobacco cessation and weight management programs, • confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including 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 Job!