Eligibility Coordinator Level 1 (Pleasanton, CA)

Essential Duties And Responsibilities

• Know the plan rules for eligibility as outlined in the Summary Plan Description (SPD) for each fund.
• Use month end reports to determine eligibility, reinstatement and termination of health care coverage.
• Carefully review month end calc report, exception report, post Health & Welfare (H&W) report, HDS flag report and pension check H&W deduction reports and ME letters. Send all ME letters to members.
• Work with data entry department to ensure that reported work hours are properly recorded and computed.
• Review Monthly Benefit Statements for eligibility accuracy.
• Work with pension department to ensure deduction amounts are correct and deducted properly for retired members and widows.
• Audit monthly H&W pension deduction reports.
• Prepare and mail enrollment packages and ID cards to all newly eligible members.
• Collect completed enrollment forms and add all members and their eligible dependents to the BeneSys computer system and any/all outside carrier systems. Send out requests for additional documentation on incomplete enrollment forms and or denials with rights to appeal.
• Request and evaluate legal documents (i.e., divorce decrees, marriage certificates, birth certificates, etc.) to determine dependent eligibility according to Plan rules.
• Review monthly status reports and self payment notices before mailed to members to ensure information is correct.
• Mail members who receive late hours or make late payments manual self-payment notices.
• Request refunds on overpayments, back payments out of system and mail refund to participant with cover letter explaining the overpayment.
• Collect and enter all self payments and balances deposits twice daily – or as assigned.
• Determine qualifying events and notify member/dependent of COBRA rights.
• Audit vendor reports and invoices.
• Create new class codes and notify programming/support of addition.
• Identify and report discrepancies in vendor invoices and month-end reports to programming/support department.
• Responsible for class code and coverage changes when member's status changes, such as adding dependents' disability, retirement, death and when dependents reach maximum age for coverage.
• Aid members and their dependents with all issues regarding eligibility for benefits; explain eligibility rules to members.
• Aid member walk-ins.
• Send proper enrollment documents to members adding children or a spouse.
• Request missing address for members from employers.
• Verify and maintain employee vital information (i.e., member and dependent address, phone number, date of birth and social security numbers).
• Change class code for members eligible for Medicare and enter HIC number in BeneSys.
• Process and return dependent QMCSO to court, member and custodial parent.
• Scan documents to OnBase as needed.

Physical Demands

• Sustained periods of sitting/standing and extensive keyboarding.
• Must be capable of operating basic office equipment, including 10-key adding machine.

Work Environment

• Typical office environment.
• Department is fast paced.
• Phone calls are continuous and callers may be upset.
• Must be able to maintain composure with difficult caller.
• Most work is done independently.

Work Schedule

• Full time.
• Monday – Friday, 8:00am - 5:00pm.
• No at-home days.

Pay

The current starting rate for this position is $32.79 per hour. This is a union position. The wage rate for this position is determined by the collective bargaining agreement and may be dependent on experience, skills, education and other business factors.