What are the responsibilities and job description for the Eligibility Member Coordinator position at Solxsys Administrative Solutions, LLC?
Overview
We are seeking an Eligibility Specialist to join our team. The ideal candidate will play a crucial role in verifying and determining patients' eligibility for various healthcare programs and services.
ESSENTIAL DUTIES AND RESPONSIBILITIES including but not limited to:
- Knowledge of Plan eligibility rules as outlined in the SPD for each Plan assigned.
- Review system for eligibility, reinstatement and termination of health care coverage.
- Carefully review Eligibility Calculation exception reports and process all follow-up tasks timely.
- Work with Contributions Department to ensure that reported work hours are properly recorded and computed.
- Review Monthly Benefit Statements for Eligibility accuracy.
- Verify that the deduction amounts are correct for retired members and survivors.
- Verify that all newly eligible members are provided enrollment packets and make sure that the enrollment process is completed.
- Requests and evaluates legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules.
- Reviews monthly status reports and self-payment notices before mailed to members to ensure information is correct.
- Make sure that all self pays recorded in the system are properly allocated to the member record to assure that eligibility is updated daily,
- Determine qualifying events and notify member/dependent of COBRA rights.
- Identifies and reports to Programming Department system errors in work hour computations.
- Audits vendor reports and invoices on a monthly basis.
- Assists members and their dependents with all issues regarding eligibility for benefits. Explain eligibility rules to members.
- Send proper enrollment documents to members adding children or a spouse.
- Process and return dependent QMCSO to court, member and custodial parent.
Job Type: Full-time
Expected hours: 40 per week
Schedule:
- Monday to Friday
Experience:
- Customer service: 3 years (Required)
Ability to Commute:
- Troy, MI 48098 (Required)
Work Location: In person