Eligibility and Claims Clerk

About the role

We are seeking an Eligibility Clerk to provide member and customer service in the areas of claims and eligibility. In this role, you will analyze and communicate outcomes—such as eligibility status, payment levels, and denials—to members and providers, following departmental workflows and policies.

Responsibilities

• Analyze eligibility status, payment levels, and claim denials.
• Communicate outcomes clearly to members and healthcare providers.
• Handle routine inquiries and resolve issues with minimal supervision.
• Adhere to departmental workflows and policies.

Requirements

• Minimum of 1 year of experience in eligibility, claims, or insurance.
• High school diploma or equivalent.
• Excellent interpersonal and customer service skills.
• Ability to work independently and manage tasks under pressure.
• Strong organizational skills and attention to detail.
• Proficiency in Microsoft Office (Excel, Word, Outlook).
• Strong oral and written communication skills.

Qualifications

• Spanish, Mandarin, or Cantonese language skills a plus.
• Legal experience a plus.

Benefits

• Medical, dental, pharmacy, and vision benefits at no cost to eligible employees and dependents.
• Paid time off (vacation, personal, sick days, and 12 paid holidays).
• 401(k) plan.
• Life insurance.
• Tuition reimbursement.
• Mental health coverage.
• Legal services benefit.
• Short-term disability benefits.

Pay

$59,295.44 per year.