Eligibility Specialist

Job Description

Job Description

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

POSITION SUMMARY: The Eligibility Specialist reports to the Director of Eligibility. This position maintains updated enrollment and benefit information for all self-insured employer groups.

PRINCIPAL DUTIES AND RESPONSIBILITIES :

• Answer telephone inquiries from insured members, employers, providers, etc., regarding enrollment and prescription issues.
• Process EDI Member Maintenance on a daily basis.
• Oversee the process of benefit additions, changes and deletions in the GBAS system within 24 hours of receipt.
• Manage the process of benefit additions, changes and deletions in the GBAS system.
• Oversee the process of prescription drug benefits additions, changes and deletions with Pharmacy Benefit Managers.
• Coordinate the printing and mailing of health ID cards to insured members.
• Provide COBRA administration for self-insured groups who request the service.
• Respond to HIPAA certificate requests.
• Run eligibility reports as needed.
• Participate in audits as needed.
• Notify management of overtime needs by completing appropriate forms.
• Perform other duties as assigned.

GENERAL EXPECTATIONS:

• Present a positive image of Consociate Health at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer or coworker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Adheres to established safety standards and utilizes proper techniques to avoid work related injuries.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Administration Division.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.

KNOWLEDGE, SKILLS AND ABILITY REQUIREMENTS:

• High School Education Required.
• Previous experience working in the insurance or benefits management field.

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid training
• Vision insurance