Eligibility Coordinator

Responsibilities

• Coordinates the input of member eligibility for all new groups
• Assists with the implementation process for new clients
• Coordinates with client contacts to ensure information received is accurate and timely
• Enrolls online management (Portal) users and maintains accounts
• Enrolls new members and/or processes terminations
• Works with multiple departments to coordinate eligibility requirements
• Utilizes both manual and systematic enrollment processes
• Reviews daily reporting for eligibility corrections
• Answers incoming telephone calls related to eligibility needs
• Ensures eligibility systems are updated and data is appropriately integrated on a daily basis
• Maintains the eligibility files for medical coverage recipients (PHI)
• Handles escalated eligibility issues to ensure problems are resolved
• Ensures that all correspondence and eligibility files are properly maintained
• Performs scheduled review and quality assurance for member eligibility
• Assists with go-lives and testing data files
• Performs various related duties as assigned, including but not limited to member communications, personal importation, overflow IC phone support, and pharmacy network tasks

Requirements

• High school diploma or equivalent required
• Post-high school or specialized training in a medical field desired
• Minimum three years of experience in a customer service position, preferably as an Office Manager or a similar service position in the healthcare industry
• Excellent communication skills and the ability to work effectively with clients, pharmacies, plan members, and internal and external contacts
• Proficient PC skills in Windows-based applications
• Health insurance background and knowledge of pharmacy terminology desired
• Ability to be flexible and quickly adapt to changing needs in the department
• Highly organized with strong attention to detail
• Flexible with scheduled work hours

Physical Demands

Requires sitting, standing, and occasional light lifting.