Eligibility Specialist

Eligibility Technical Specialist

Responsibilities:

• Handle high-volume inbound calls and emails related to eligibility, enrollment, and coverage questions
  
  
• Process eligibility updates including new enrollments, terminations, and dependent coverage changes
  
  
• Verify and maintain accurate participant data, records, and documentation
  
  
• Assist with insurance verification, benefits explanation, COBRA, HIPAA, and ACA compliance
  
  
• Coordinate with internal teams, IT, and external vendors to resolve data discrepancies and system issues
  
  
• Perform system testing and support troubleshooting of eligibility and workflow errors
  
  
• Maintain tracking logs for exceptions and ensure timely updates
  
  
• Support reporting by gathering and analyzing eligibility data
  
  
• Assist with training staff on systems, processes, and workarounds
  
  
• Complete administrative tasks including filing, documentation, and compliance support
  
  

Requirements:

• 
  Bachelor's degree preferred, Associates degree required
  
  
  
  
• 
  Experience in healthcare, benefits administration, or insurance eligibility
  
  
  
  
• Knowledge of COBRA, HIPAA, ACA, and healthcare eligibility processes
  
  
• Strong data entry accuracy and attention to detail
  
  
• Ability to manage multiple tasks in a high-volume environment
  
  
• Strong analytical, organizational, and problem-solving skills
  
  
• Excellent written and verbal communication skills
  
  
• Proficiency in Microsoft Office (Excel, Word, PowerPoint); experience with data tools a plus
  
  
• Ability to quickly learn new systems and adapt to process changes
  
  

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.