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Eligibility Enrollment Specialist I /Grade 5

icon building Company : Magnacare
icon briefcase Job Type : Full Time
icon geo-alt Las Vegas, Nv

Number of Applicants

 : 

000+

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Job Description - 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.
 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
 
 
Original job Eligibility Enrollment Specialist I /Grade 5 posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs.
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