Job Summary:
The Eligibility Specialist will process benefit entries and validate information. This role will respond to eligibility and other enrollment related issues involving member specific information; partner directly with clients, and/or vendors, to resolve problems and achieve positive outcome.
Duties and Responsibilities:
· Perform eligibility additions, terminations, and changes for new and renewal clients from electronic files, paper forms and portal. Confirm that enrollments or changes are done per legal or client specifications.
· Validate enrollments to ensure that they are activated timely, and that information is correctly and completely entered. Verify that information needed for data transfer to affiliated vendors is included.
· Provide feedback on implementations and renewals for eligibility processing to improve processes, workflows, and products.
· Interface with providers, vendors, and internal departments to address billing or technical issues related to eligibility.
· Create and maintain system access logons for Brokers and Clients.
· Receive and respond to inquiries and data transfers from clients meeting department turn-around time for responses and queue levels.
· Support team with review of system configuration and processes to ensure optimum processing.
· Audit and validate ID card processing.
· Generate and mail required notices for all product lines.
Required Knowledge, Skills, and Abilities:
· High school diploma or equivalent
· 2 years of experience in eligibility, enrollment, or benefits customer service role focused on eligibility
· Knowledge of health insurance plans and employee benefits
· Experience with benefit administration platforms such as Javelina preferred
Job Type: Temp to perm
Pay: R10 000,00 - R20 000,00 per month
