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.
Essential Qualifications- 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
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