ELIGIBILITY SPECIALIST

• Processes manual eligibility files and loads enrollments into the claims processing system.
• Establishes and maintains effective communication with clients, members, and other departments either by phone or correspondence.
• Ensures positive customer experiences, both externally and internally.
• Maintains professional communication standards throughout interactions.
• Utilizes critical thinking skills to analyze detailed information accurately.
• Identifies issues and discrepancies in eligibility data or billing statements.
• Proposes solutions and improvements to streamline processes.
• Manages multiple tasks simultaneously, demonstrating strong multitasking abilities.
• Meets deadlines consistently while maintaining accuracy and attention to detail.
• Maintains regular attendance and punctuality to ensure operational continuity.
• Demonstrates basic computer skills with proficiency in Microsoft Office programs (e.g., Word, Excel).
• Utilizes software systems effectively for data entry, document management, and reporting purposes.
• Works collaboratively as a member of the Eligibility team and interacts effectively with other departments.
• Supports team goals and contributes positively to team dynamics.
• Maintains a professional appearance and demeanor in all interactions.
• Upholds confidentiality of sensitive material and information in accordance with company policies and regulations.
• All other duties as assigned by Eligibility and Premiums Manager.

Qualifications:

Must Haves:

• Attention to Detail: Essential for accurate data entry, documentation, and compliance with regulatory standards.
• Organizational Skills: Ability to manage multiple tasks, prioritize effectively, and meet deadlines consistently.
• Adaptability: Capacity to learn new systems, processes, and industry regulations quickly and effectively.
• Team Player: Demonstrated ability to collaborate with colleagues, share knowledge, and contribute positively to team dynamics.
• Problem-Solving Skills: Proven ability to identify issues, analyze data, and propose practical solutions to ensure operational efficiency.
• Customer Focus: Commitment to delivering outstanding service to clients, understanding their needs, and ensuring satisfaction.

Nice to Haves:

• Industry Experience: Previous experience in the insurance or healthcare industry, particularly in enrollment processes, would be advantageous.
• Technical Proficiency: Familiarity with specific software or platforms used in enrollment management.
• Communication Skills: Strong verbal and written communication abilities, including the ability to communicate complex information clearly and effectively.
• Analytical Skills: Ability to interpret data, identify trends, and make data-driven recommendations for process improvements.