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Eligibility Specialist -Health Insurance
Job
Career Strategies, Inc.
Glendale, CA (In Person)
$56,000 Salary, Full-Time
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Job Description
The Eligibility Technical Specialist serves our members and their families by providing important information and support with Health benefit enrollment and Health eligibility requirements. This includes enrollment assistance, address changes, explaining earnings requirements, basic plan benefits, COBRA, HIPAA and related aspects of the Affordable Care Act. Come join a great company! that cares about their employees! This is a High-Call-Volume position. Cross-trained to process the departments workload including but not limited to: new eligibility, loss of coverage etc., dependent coverage, pharmacy issues, COBRA Administration, Monthly/Quarterly/Annual processes and more Maintains lists of any Participants with coverage exception issues that must be manually updated (weekly/monthly) and performs necessary data entry Coordinates with the Eligibility Team, the I.T.'s B.A. team, and all vendors (i.e., Anthem Blue Cross, Express Scripts, Delta Dental, VSP and the UCLA/Motion Picture Fund) to identify and resolve eligibility data issues discovered in our system, data file transmissions and vendor discrepancy reports Performs system testing (as needed) of all proposed resolutions to Help Desk Tickets and reports results to the department Assistant Manager and/or Manager Performs manual calculation of Qualified Certified Retiree Health Quarters for all requests received from the Pension Department Assists the Sr. Eligibility Technical Specialist in gathering all necessary data (electronic and manual) for monthly and quarterly performance reports. Requirements Bachelor's degree in Healthcare, Math, Engineering, or related field. Strong analytical and interpersonal skills Ability to work on multiple assignments simultaneously Excellent organizational skills including ability to work under pressure and deal with multiple tasks Knowledge and experience with software, tools and processes used in the healthcare environment Proficient in use of Microsoft Excel Power Query, BI, PowerPoint, Word, Visio Data Analysis skills Strong written and verbal communication skills; ability to present analysis and conclusions with clarity and professionalism Detail oriented and deadline driven in order to complete tasks and meet required deadlines Experience in Medical Insurance eligibility and claims processing (PPO/HMO) Experience and knowledge of healthcare regulatory policies, such as,