We’re looking for…
An Eligibility Specialist that will be able to process benefit entries and validate information. You will respond to eligibility and other enrollment related issues involving member specific information; partner directly with clients, and/or vendors, to resolve problems and achieve positive outcomes.
Who are you?
- You are able to demonstrate the ability to use a computer with expert-level keyboard and navigation skills, as well as the ability to quickly learn new software programs.
- You have the ability to communicate clearly and professionally with both internal and external customers.
- You know how to maintain confidentiality and exercise discretion with sensitive information
- You are have an eye for detail and great time management skills
- You are capable of working effectively both independently and as part of a team to achieve established goals. Understand the roles of others and empower team members to take responsibility for their success.
What’s the role?
You will be responsible for:
- Manage eligibility additions and terminations
- Changes for new and renewing clients using electronic files, paper forms and portals.
- Ensure enrollments and changes comply with legal requirements and client specifications.
- Confirm that enrollments are activated promptly and that information is accurately and fully entered.
- Ensure all necessary data for transfers to affiliated vendors is included.
- Provide feedback on eligibility processing during implementations and renewals to enhance processes, workflows, and products.
- Collaborate with providers, vendors, and internal departments to resolve billing or technical issues related to eligibility.
- Create and maintain system logins for Brokers and Clients.
- Respond to client inquiries and manage data transfers, adhering to department turnaround times and maintaining queue levels.
- Assist the team in reviewing system configurations and processes to ensure optimal processing.
- Audit and validate ID card processing, and generate and mail required notices for all product lines.
Boxes to tick…
- Matric
- Diploma or equivalent
- 2 years of experience in eligibility, enrollment, or benefits customer service role focused on eligibility
- You have a strong knowledge of health insurance plans and employee benefits.
- You have a familiarity with benefit administration platforms such as Javelina.
- You are proficient in standard computer applications, including MS Word, Excel, Outlook, and PowerPoint.
Working Hours: 2pm - 11pm