Position Summary
-Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns.
– Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.
– Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
– Monitors daily status reports assessing output for developing trends potentially impacting service levels.
– Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
– Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
– Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).
– Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
– When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.
– Interprets and translates client benefits and supporting account structure against internal systems/applications
– Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services.
– Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.
Required Qualifications
– 1-3 years strong data entry skills
– 1-3 years Microsoft Suite
– 1-3 years customer service
