Medical Data Entry Clerk

Job DescriptionJob Description

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Job Overview:
Search Solution Group is seeking a Contract Eligibility Specialist on behalf of our client, a health benefits program that provides medical, dental, vision, and life insurance benefits to eligible union members and their dependents. This role is responsible for determining and maintaining participant eligibility, processing enrollments, and ensuring the accuracy of eligibility records. The ideal candidate will have strong administrative and member service experience, excellent attention to detail, and a solid understanding of benefits eligibility processes while maintaining strict compliance with HIPAA policies.

Key Responsibilities:

• Determine, maintain, and monitor participant eligibility for various benefit programs
• Process enrollments and post eligibility updates in a timely and accurate manner
• Respond to telephone and email inquiries from participants, union representatives, and employers while adhering to HIPAA Privacy and Security policies
• Verify and update participant contact information, including address, phone number, and email
• Manage incoming and outgoing participant communications including letters, forms, documents, and emails
• Verify and process incoming forms and documentation according to program policies, including SPAFF, QMSCO, HIPAA authorization forms, life event forms, enrollment forms, biometric screening forms, beneficiary forms, and dependent documentation
• Prepare and distribute outgoing forms and documents in compliance with internal policies
• Analyze contracts and Collective Bargaining Agreements (CBA) to determine eligibility and coverage requirements
• Post eligibility updates on a monthly basis
• Verify and audit spousal fees
• Process and balance monthly employer and employee contributions
• Verify, audit, prepare, and process refunds as necessary
• Process termination and drop reports
• Prepare and send vendor reports
• Perform routine audits to ensure accuracy and compliance
• Assist with Member Services phone calls when directed by management
• Provide backup support to member services and support teams as needed
• Perform additional duties as assigned

Requirements include:

Education:

• High School Diploma or GED equivalent required

Experience:

• Minimum of 1 year of experience in a Member Services role required
• Administrative experience including filing, scanning, copying, and data entry required
• Experience working with benefits eligibility, health plans, or union benefits programs preferred

Skills:

• Proficiency in Microsoft Office Suite
• Strong data entry and typing skills
• Strong organizational and multitasking abilities
• Excellent communication and customer service skills
• Analytical and problem-solving skills
• Strong numerical proficiency

Certifications:

• HIPAA Privacy and Security Training required

Knowledge:

• Basic understanding of Summary Plan Descriptions (SPDs) and plan documents
• Familiarity with Collective Bargaining Agreements (CBAs) and eligibility rules
• Knowledge of benefits provisions, contribution xhqgsiq requirements, and payment procedures
• Basic understanding of Short-Term Disability guidelines
• Knowledge of eligibility rules including hour qualifications and tunnel periods

Key Competencies:

• Attention to Detail: Ensures accuracy when reviewing documentation, processing eligibility, and performing audits
• Teamwork and Cooperation: Works effectively with internal teams and supports cross-functional collaboration
• Communication: Provides clear and professional communication to participants, employers, and union representatives
• Organization: Manages multiple administrative tasks while maintaining efficiency and accuracy
• Analytical Thinking: Reviews documentation and contracts to determine eligibility requirements
• Self-Motivation: Demonstrates initiative and accountability in completing tasks and meeting deadlines
• Flexibility: Adapts to changing processes, systems, and organizational needs