Eligibility Specialist

Eligibility Specialist

This is a non-exempt position with primary responsibility for handling enrollment and eligibility for SIHO customers. This position is also responsible for assisting employer contacts with needs pertaining to eligibility and providing reports and other information as needed.

Brief Description of Duties:

• Respond to telephonic, written inquiries, and emails from accounts concerning eligibility issues.
• Assist internal customers concerning eligibility issues.
• Enroll, terminate, and change eligibility information as requested.
• Initiate and handle student certification, tax dependent verification and disabled dependent verification.
• Maintain eligibility audit reports.
• Process enrollment of new groups as assigned.
• Handle terminations of groups as assigned.
• Track ID Card orders and re-order as needed.
• Track eligibility issues and interactions in the membership system.
• Prepare and communicate special reports as required by accounts.
• Complete special projects (including research) as assigned by the supervisor.
• Develop and maintain statistical data as required.
• Create and mail letters of creditable coverage.
• Represent the department when needed for internal and external company meetings.
• Perform other Eligibility Department duties as assigned

Minimum Skills Requirement:

• Expert level computer skills (Microsoft Excel and Word)
• Ability to work with databases and software applications (e.g., HSP, HealthEx, etc.)
• Highly collaborative with a positive mindset – highly functional in a team-based environment
• Detail oriented - high accuracy rate and attention to detail
• Demonstrated problem solving and analytical skills
• Proven organization and time management skills
• Excellent oral and written communications skills
• Excellent customer service skills
• General knowledge and understanding of health insurance
• Ability to work at a self-directed pace in a changing, multi-task environment
• Professional appearance and presence
• Commitment to support and maintain confidentiality in accordance with HIPAA guidelines
• Current PMAS performance evaluation of "3" or higher (for internal candidates)