Eligibility Specialist - Healthcare / Insurance
We have an immediate opening for an experienced Eligibility
Specialist to join our Eligibility team.
The Eligibility Specialist will report directly to our Eligibility
and Office Admin Manager and be responsible for ensuring member
eligibility events are updated timely and accurately.
The successful candidate will have a good understanding of Health
Insurance eligibility practices (to include Coordination of Benefits),
pose excellent organizational and time management skills, pay
attention to detail, and keep meticulous records.
This is a full time and permanent role and will be based out of our
Lyndhurst, NJ office.
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 escalations.
* Coordinate with Account Management and Implementation for all new
and renewing clients.
* Coordinate with PBM, member, provider, and plan professionals to
resolve pharmacy inquiries.
* Notify clients of return mail and request address updates as needed.
* Process coordination of benefits as needed.
* Prepare confirmation and credible coverage letters as needed.
* Process ID card requests as needed.
* Maintain daily event through our ticketing platform.
* Perform other related duties and projects as assigned.
Knowledge, Skills, and Abilities:
* Must have a strong work ethic.
* Knowledge of eligibility best practices.
* Excellent organizational and time management skills.
* Excellent Customer services/communication skills by both email and phone.
* Able to work comfortably in a fast-paced environment.
* Strong analytical and critical thinking skills.
* Ability to consistently meet deadlines.
* Ability to work independently and within a team.
* Ability to multi-task, problem solve, prioritize and follow-up.
* Proficient in Microsoft Excel, Word, Access, Adobe Acrobat Pro.
* Ability to work within a CRM system to track daily work situations.
* Must be able to meet and attain performance expectations.
We value our employees and provide a supportive working environment.
We are an Affirmative Action - Equal Opportunity Employer (Minorities
/ Females / Vets / Disabled).
We provide equal opportunities to all employees and applicants for
employment without regard to sex, race, color, religion, marital
status, national origin, age, genetic information, sexual orientation,
gender (including gender identity/expression), disability, veteran
status and military status, pregnancy or pregnancy-related medical
conditions, or any other factor that may be protected by law.