Electronic Eligibility Administrator

Job Title

Under the direction of the Group Service Center Manager, performs duties involving the planning and implementation of electronic transmission and administration of eligibility, internal and external coordination when appropriate as well as training and guidance for clarification and understanding of electronic processes. Builds and maintains customer relationships in a professional manner both internally and externally. Assists the Group Service Center Manager in ensuring the company and departmental objectives and goals are met.

Essential Duties and Responsibilities

• Under the direction of the Group Service Center Manager, performs duties involving the planning and implementation of electronic transmission and administration of eligibility, internal and external coordination when appropriate, as well as training and guidance for clarification and understanding of electronic processes. Builds and maintains customer relationships in a professional manner both internally and externally. Assists the Group Service Center Manager in ensuring the company and departmental objectives and goals are met.
• Develops and maintains strong relationships with HDS clients in assisting with enrollment transitions and problem resolution based on the knowledge and understanding of the HDS database system. Determines and recommends the best solutions for electronic enrollment transmission based on the client and HDS's system capabilities. Works to develop high standards for customer relations and service satisfaction of eligibility-related matters, including internal and external training of BESS reports.
• Monitors and coordinates work with other departments, such as Sales with transitions of new clients, transitions of Third-Party Administrators for existing clients, problem research and resolution; Dental Claims and Customer Service with eligibility research for claims-related inquiries, and ISD with systems and applications enhancements and testing.
• Manages Daily Task Lists, distribution and assignment of electronic eligibility transaction processing. Monitors workload of transactions of the Group Service Center's daily eligibility activities. Evaluates effectiveness of eligibility processes and procedures and proposes recommendations to the Group Service Center Manager.
• Assists the Group Service Center team with the design, writing, maintenance and production of departmental manuals, including but not limited to standards of operations, flow chart and user processing manuals.
• Other Duties and Responsibilities:
  • Assists the Group Service Center Administrator and/or Manager with special projects when necessary.
  • Assists the Group Service Center department in processing daily enrollment activities as necessary once the daily electronic processing is completed and during high volume period or during periods of low staffing.

Minimum Qualifications and Experience

Education

• Bachelor's degree in Business Administration, Information & Computer Sciences, Management Information Systems or an equivalent combination of education, training or working experience.

Experience

• Three (3) years progressively responsible office administration experience, preferably in the areas of servicing groups, group contracts and/or customer service.
• Work experience to include Microsoft suite of applications, with 1-2 years experience with Excel, preferably with advanced spreadsheet features and functions.
• Knowledge of programming languages such as SQL or language is desirable.

Skills and Knowledge

• Ability to organize, analyze and problem-solve complex problems.
• Ability to handle multiple tasks and prioritize with some distractions.
• Ability to communicate both orally and in writing with all levels of staff, customers, consultants/brokers, and vendors on sensitive matters.
• Technical knowledge and experience with using computer applications for problem-solving and answering staff questions (prefer Windows, and Word).
• Ability to focus on detail.
• Ability to handle all information in a confidential manner and in compliance with federal and state laws/regulations (i.e. HIPAA, PHI).

Work Environment

• Hybrid, minimum three (3) days in the office.
• Monday - Friday, weekend and holiday work may be required.

Note: The above information on this description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job. Hawaii Dental Service has the right to add to, revise, or delete information in this description. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential functions of this position.