Eligibility Specialist

Provide support to members and their families by assisting with health benefit eligibility, enrollment, and coverage questions. Deliver clear guidance on benefits, requirements, and policies while ensuring accurate data management and excellent customer service.

Responsibilities:

• Respond to member inquiries via phone, email, and service queues regarding eligibility, enrollment, COBRA, HIPAA, and benefits
• Process eligibility updates including new coverage, terminations, and dependent changes
• Maintain and update participant records, including manual adjustments and data entry
• Coordinate with internal teams, IT, and healthcare vendors to resolve eligibility and system issues
• Assist with reporting, audits, and monthly/quarterly processing activities
• Support training of new staff and provide guidance on system processes and workflows
• Perform data validation, testing, and troubleshooting to ensure system accuracy
• Analyze workflows, identify inefficiencies, and recommend process improvements
• Ensure compliance with healthcare regulations and company policies
• Deliver excellent customer service to members, providers, and internal stakeholders

Requirements / Qualifications:

• Bachelor's degree or equivalent work experience
• Strong analytical, organizational, and problem-solving skills
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment
• Proficiency in Microsoft Office (Excel, Word, PowerPoint); data analysis skills preferred
• Experience with healthcare systems, eligibility, or insurance processes preferred
• Knowledge of healthcare regulations (COBRA, HIPAA, ACA)
• Strong written and verbal communication skills
• Ability to quickly learn new systems, tools, and processes
• Detail-oriented with a high level of accuracy and professionalism