Eligibility Consultant - PaperPrimary Location: Newark, Delaware
Additional Locations: DE-Newark Apply
|DE based position supporting multiple health plans. The Enrollment Representative under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.|
- Responds, researches, and resolves eligibility and/or billing related issues involving member specific information
- Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.Monitors daily status reports assessing output for developing trends potentially impacting service levels.
- Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
- Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
- Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).
- Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI).
- Determines and communicates standard service charges to internal/external customers related to paper eligibility activities
- May include negotiating and communicating charges pertaining to non-standard services. Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.
- Attention to detail and accuracy
- Problem solving skills
- Strong organization skills
- Understands the impact of work to other teams and downstream support areas.
- Ability to analyze and research data to make appropriate corrections as necessary.
- Strong verbal and written communication skills.
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