Eligibility Specialist

Responsibilities

• Respond to member inquiries via phone, email, and service queues regarding eligibility, enrollment, COBRA, HIPAA, and benefits
• Process eligibility updates including new coverage, terminations, and dependent changes
• Maintain and update participant records, including manual adjustments and data entry
• Cook with internal teams, IT, and healthcare vendors to resolve eligibility and system issues
• Assist with reporting, audits, and monthly/quarterly processing activities
• Support training of new staff and provide guidance on system processes and workflows
• Perform data validation, testing, and troubleshooting to ensure system accuracy
• Analyze workflows, identify inefficiencies, and recommend process improvements
• Ensure compliance with healthcare regulations and company policies
• Deliver excellent customer service to members, providers, and internal stakeholders

Qualifications

• Bachelor's degree or equivalent work experience
• Strong analytical, organizational, and problem-solving skills
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment
• Proficiency in Microsoft Office (Excel, Word, PowerPoint); data analysis skills preferred
• Experience with healthcare systems, eligibility, or insurance processes preferred
• Knowledge of healthcare regulations (COBRA, HIPAA, ACA)
• Strong written and verbal communication skills
• Ability to quickly learn new systems, tools, and processes
• Detail-oriented with a high level of accuracy and professionalism