Eligibility Coordinator Level 1 (Pleasanton, CA)

Eligibility Coordinator Level 1 (Pleasanton, CA)

The Eligibility Coordinator determines, maintains and terminates member and/or dependent eligibility for health care benefits. This is a collective bargaining union position. Essential duties and responsibilities include but not limited to:

• Know the plan rules for eligibility as outlined in the Summary Plan Description (SPD) for each fund.
• Use month end reports to determine eligibility, reinstatement and termination of health care coverage.
• Carefully review month end calc report, exception report, post Health & Welfare (H&W) report, HDS flag report and pension check H&W deduction reports and ME letters. Send all ME letters to members.
• Work with data entry department to ensure that reported work hours are properly recorded and computed.
• Review Monthly Benefit Statements for eligibility accuracy.
• Work with pension department to ensure deduction amounts are correct and deducted properly for retired members and widows.
• Audit monthly H&W pension deduction reports.
• Prepare and mail enrollment packages and ID cards to all newly eligible members.
• Collect completed enrollment forms and add all members and their eligible dependents to the BeneSys computer system and any/all outside carrier systems. Send out requests for additional documentation on incomplete enrollment forms and or denials with rights to appeal.
• Request and evaluate legal documents (i.e., divorce decrees, marriage certificates, birth certificates, etc.) to determine dependent eligibility according to Plan rules.
• Review monthly status reports and self payment notices before mailed to members to ensure information is correct.
• Mail members who receive late hours or make late payments manual self-payment notices. Request refunds on overpayments, back payments out of system and mail refund to participant with cover letter explaining the overpayment.
• Collect and enter all self payments and balances deposits twice daily – or as assigned.
• Determine qualifying events and notify member/dependent of COBRA rights.
• Identify and report to programming department system errors in work hour computations.
• Audit vendor reports and invoices.
• Create new class codes and notify programming/support of addition.
• Identify and report discrepancies in vendor invoices and month-end reports to programming/support department.
• Responsible for class code and coverage changes when member's status changes, such as adding dependents' disability, retirement, death and when dependents reach maximum age for coverage.
• Assist members and their dependents with all issues regarding eligibility for benefits; explain eligibility rules to members.
• Assist member walk-ins.
• Send proper enrollment documents to members adding children or a spouse.
• Request missing address for members from employers.
• Verify and maintain employee vital information (i.e., member and dependent address, phone number, date of birth and social security numbers).
• Change class code for members eligible for Medicare and enter HIC number in BeneSys.
• Process and return dependent QMCSO to court, member and custodial parent.
• Scan documents to OnBase as needed.
• Regular and predictable attendance is an essential function of this job.

Eligibility Coordinator Levels:

• Level I - Entry level position. General math and office skills needed. Excellent customer service and phone skills. Must be proficient in MS Word, Excel and Outlook. Ability to follow direction. Ability to administer and or back-up funds. Ability to process member information, including COBRA, Supplemental Unemployment Benefits, and Disability benefits. Ability to write appeals. Ability to multi-task.
• Level II - Must be proficient at all Level I skills. Thorough understanding of BeneSys systems including Benefit Driven and Legacy. Complete understanding of department processes and procedures. Complete understanding of COBRA and HIPAA Laws. Ability to troubleshoot and communicate issues relating to system's eligibility calculations. Strong communication skills (verbal and written). Ability to exercise good judgment. Ability to administer several plans.
• Level III - Must be proficient in all Level I and II skills. Thorough understanding of all West Coast Plans. Ability to create class codes, including mapping of plan. Ability to analyze new plans for conversions. Ability to train and assist new hires, as well as provide support. Ability to work with little direction. Ability to assist department manager with special projects.
• Unit Leader - Must be proficient in all Level I - Level III skills. Ability to handle elevated issues. Must possess leadership skills and the ability to both motivate and assist the Eligibility staff. Ability to troubleshoot eligibility issues. Good "people skills" for building relationships with colleagues at all levels. Ability to plan and prioritize own work and other Coordinators' work. Must have solid decision making ability. Must demonstrate initiative, ability to multi task and ability to represent the department.

Education and/or Experience - Post High School education or prior related work experience preferred. Language Skills - Ability to read and interpret eligibility rules as outlined in the SPD's, user manuals for on-line services, department rules and procedures manual and COBRA compliance manual. Ability to speak clearly and effectively explain to members, dependents, providers and union officials month-to-month eligibility for coverage. Mathematical Skills - Must have solid foundation in basic math skills, including working with fractions and percentages. Ability to calculate hours and rates to determine self payments and hour banks. Reasoning Ability - Must be capable of thoroughly analyzing vendor invoices and all month-end reports; finding and correcting discrepancies in member's eligibility; and understanding and applying Plan rules to analyze members' eligibility. Must be able to multi-task. Must be detailed oriented.

Physical Demands - Sustained periods of sitting/standing and extensive keyboarding. Must be capable of operating basic office equipment, including 10-key adding machine. Work Environment - Typical office environment. Department is fast paced. Phone calls are continuous and callers may be upset. Must be able to maintain composure with difficult caller. Most work is done independently.

Work Schedule - Full time. Monday – Friday, 8:00am - 5:00pm. Required in office (no at-home days).

Competitive Benefits:

• Medical/Dental/Vision, with option for dependent coverage
• Flexible spending accounts
• Company-paid basic life/AD&D, short-term disability, long-term disability insurance
• 15 days Paid Time Off during first full calendar year
• 11 paid holidays
• Up to 5 days of paid bereavement leave
• Up to 20 days of paid jury duty leave
• 401(k) with employer match

Pay - The current starting rate for this position is $32.79 per hour. This is a union position. The wage rate for this position is determined by the collective bargaining agreement and may be dependent on experience, skills, education and other business factors.

Our Culture:

• Collaboration: working together across 31 locations to achieve the best for the company and our clients
• Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
• Integrity: doing what we say we will do. Upholding strong ethical and moral principles

ADA & EEO Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.