Electronic Eligibility ConsultantPrimary Location: Plymouth, MN
Additional Locations: MN-Plymouth Apply
*** MUST be in Office in Plymouth, MN ***
- Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
- Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
- Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors.
- Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.
- Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.
- Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information.
- Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
- Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
- Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity.
- Utilizes and interprets on line resources to understand customer’s account structure and benefits.
- May assist with the development of such resources.
- Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.
- Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
- Excel & Outlook Experience is REQUIRED
- Ability to analyze and research data to make appropriate corrections as necessary.
- Understands the impact of work to other teams and downstream support areas.
- Strong verbal and written communication skills.
- Sound understanding of system errors and how to resolve efficiently.
- Strong organization skills.
- Problem solving skills.
- Attention to detail and accuracy.
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