What are the responsibilities and job description for the Eligibility Specialist position at Curative HR LLC?
The Eligibility Specialist is responsible for all administrative processing of Curative’s client’s new
enrollment and ensuring that their routine maintenance eligibility is updated timely and accurately. This
role will work with clients directly along with their agent of record. This position is responsible for
accurate reporting of all changes for the account management and implementation department.
Essential Duties and Responsibilities:
Process all transaction types, such as adds, term, changes, group discrepancies and other
eligibility related tasks.
Review and process all manual and / or EDI enrollment transactions (adds, changes, terms)
received from clients or internal sources in accordance with Certificates of Coverage and
Summary Plan Descriptions.
Produce electronic spreadsheets and /or reports for audit and processing purposes.
Research and correct escalated billing issues.
Perform full reconciliations on accounts to confirm that the group is in compliance.
Meet established processing cycle time standards and production due dates.
Identify inefficiencies within the established processes and suggest possible solutions to save
time, reduce risk, and increase quality of work.
Track and Trend enrollment data for CQI
Be a liaison to Curative overall on industry and market demands to impact process, product, and
tech development, along with any process improvements.
Required Experience/Skills
Outstanding organizational, time management and follow-up skills.
Knowledge of processing Electronic Data Interchange (EDI) file updates.
Knowledge of Healthcare eligibility and billing procedures as well as HIPAA, Cobra and ERISA.
Proficient with Microsoft Office Suite, Google Workspace and Adobe
Experience with CRM software preferably Salesforce
Ability to communicate effectively and interpret a variety of instructions in a fast-paced
environment.
Bachelor’s and / or an associate degree plus 3 years administrative expertise or any combination
education and experience that has been achieved and is equivalent to the stated education and
required knowledge.
