Enrollment and Eligibility Specialist

Primary Responsibilities

• Create, audit, process and update the member and eligible dependents’ profile(s) into the enrollment database & update the database with changes.
• Reconcile eligibility discrepancies, analyze transactional data & submit retroactive eligibility changes.
• Troubleshoot Enrollment and Eligibility related inquiries from the Clients, Employer Partners, Health Plan Carriers, the COBRA vendor, and Call Center Representatives.
• Works directly with the Finance team to review, process, and resolve inquiries from the employers and premium related issues: including outreach to employers, the client and State officials --as needed.
• Contact Employers regarding delinquencies and late file submissions –when applicable.
• Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of requests from the client, employers, and members.
• Participate in activities designed to improve customer satisfaction and business performance.
• Solve problems that are sometimes out of the ordinary and that may require reliance on conceptual thinking. Maintain broad knowledge of client requirements, procedures and key contacts.
• Support projects and other departments in completing tasks/projects.

About

At Brighton Health Plan Solutions (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it. Based in New York City, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing tangible innovation to the health care delivery system. Our team is committed to transforming how health care is accessed and delivered. We believe that cost, quality, and population health are optimized when people have long term relationships with their health care providers – and that’s why we’re creating new products that today do not exist anywhere in the New York/New Jersey market. With a growing labor business under the well-known MagnaCare brand, the launch of Create - a new marketplace of health systems focused on self-insured commercial health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners.