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

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.