Our member, an innovative health benefits provider, has an immediate
opening for a focused Eligibility Specialist to join our Eligibility
team. In this role, you will report directly to the Eligibility and
Office Admin Manager and be responsible for updating members’
eligibility in a timely and accurate manner. The successful
Eligibility Specialist will also pair with the Pharmacy Benefit
Specialist to ensure member eligibility coordinates with pharmacy
Specific Job Responsibilities
- Review, approve, and process enrollment events for member
additions, terminations, and changes.
- Respond to eligibility updates received through the portal, email,
fax, and phone calls.
- Assist Customer Service and Client Support with escalated issues.
- Coordinate with Account Management and Implementation for all new
and renewing clients.
- Coordinate with Pharmacy Benefit Specialist to resolve pharmacy
- Notify clients of returned mail and request address updates as
- Process Coordination of Benefits as needed.
- Prepare confirmation and credible coverage letters as needed.
- Process ID card requests as needed.
- Manage tracking tool to record and document the activity of all requests.
- Perform other related duties and projects as assigned.