Eligibility Specialist

Overview

Job Summary: Provides support to Eligibility Supervisor for all aspects of customer service, account management, and all other administrative projects. This position will act as a partnership role within the eligibility department and will assist in the maintenance of eligibility, EOB’s, DMR’s, ID card printing and maintenance, and other tasks as assigned.

Responsibilities

• Act as eligibility department partner; provide resolution for incoming eligibility related issues. To include email correspondence, IT tickets, ACD phone coverage, in person meetings, Team meetings and partner and/or client meetings.

• Perform eligibility duties, including the processing and maintenance of daily/weekly eligibility files.

• Assist in the monthly distribution of daily, monthly, and quarterly reporting including census reports.

• Provide support for bi-weekly and/or monthly eligibility audit process.

• Monitor and respond to daily fallout reports and threshold reporting.

• BI partnership for escalated items and tasks, as well as the day-to-day data management collaboration. As well as partnering with other operational teams such as Implementation, Benefit Review, BOM, Clinical, ProActPlus, and so on. Including the Account Management and Account Coordinator staff.

• Help Desk ACD phone coverage for incoming calls and directing incoming calls to appropriate staff members.

• Provide Help Desk resolution of customer service issues to ensure complete client satisfaction.

• Responsible for DMR and EOB duties to ensure complete client satisfaction.

• Assist with the coordination and implementation for the startup of new clients and new TPA partners to include new group enrollments, changes, and terminations.

• Assist with on-site client orientation, health fairs and business conferences.

• Assist with on-site resolution of customer service issues to clients.

• Performs office duties as needed (includes copying, collating, mailings, filing).

• Responsible for completing all mandatory and regulatory training programs.

• Perform other duties as assigned.

Qualifications

Educational Requirements:

• Minimum: High School Diploma or GED

Experience:

• Preferred: 0-2 years experience as Rx Technician or Customer Service Representative in a health care related service.

Compensation:

$17.50 - 20.00 per hour.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.

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Job Locations US-NY-Gouverneur

Posted Date 2 months ago (5/7/2026 10:00 AM)

Requisition ID 2026-15667

# of Openings 1

Category Administrative/Clerical

Location : Location US-NY-Gouverneur