The Eligibility Processor will review and process eligibility inquiries as well as determine, maintain, and terminate member and/or dependent eligibility for healthcare benefits.

Processors provide support to the healthcare service team, supervisors, and manager, when necessary. Essential Duties and Responsibilities include but not limited to Understand the plan rules for eligibility as outlined in the Summary Plan Description (SPD) Process month end reporting Use reports to determine eligibility, reinstatement, or termination of coverage Prepare & mail enrollment packages and ID cards for newly eligible members Review calc reports and exception reports to update eligibility, as needed QA self-payment notices, COBRA notices, status slips, member/dependent letters to ensure accurate information and timely mailing to participants Processing eligibility documents in OnBase for clients New member forms Vital information forms Medicare information forms Other insurance information forms Member/dependent PHI ACH authorization Death notifications Qualified Medical Child Support Order (QMSCO) Eligibility appeals Loss of time credits Enrollment escalation requests (call center resolution form) Vendor file approvals Vendor discrepancy reports Evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules Process payments for health & welfare coverage Request missing information from members Process eligibility escalations within 24 hours and call back members with updates, as needed Work with the pension department to ensure H&W deduction amounts are correct and properly set up for retired members and surviving spouses Responsible for class code and coverage changes when member's status changes, such as adding/terming dependents, disability, retirement, or death Understand Medicare rules and regulations to determine eligibility for Medicare benefits and update coordination of benefits in appropriate systems Verify and maintain employee demographic information, such as member or dependent address, contact numbers, birth date, social security number, or MBI number Comment system with appropriate updates based on documentation received Review and approve any plan changes, such as H&W rate changes, eligibility rule changes, or benefit changes with a vendor Meet daily/weekly quota requirements set by management team Update Redbook when necessary; within 24-48 hours of change notification Be knowledgeable of policies, procedures, and coverage of various funds Regular and predictable attendance is an essential function of this job Qualifications

Excellent multi-tasking skills are a must. Preferred Qualification
Spanish speaking. Education and/or Experience
High school diploma or GED and one year of eligibility experience. Language Skills
Must speak clearly and professionally. Ability to understand directions and follow them to completion of requested task. Mathematical Skills
General math skills. Reasoning Ability
Ability to apply common sense to carry out detailed written or verbal instructions. Work Environment
Fast-paced department. Must be able to work independently as well as in a team, must be able to multi-task and detailed oriented. Work Schedule
Full time. Monday
Friday, 7:30am
4:30 pm.

Requires in-office days but also offers at-home flexibility after 90 days. Competitive Benefits and Compensation Package 12 paid holidays Paid Time Off (PTO) Pro-rated during first year of employment 15 days of PTO provided in the next calendar year! 3 days paid bereavement Up to 20 days paid jury leave Medical, dental, and vision insurance, with option for dependent coverage Company-paid basic life, short-term disability, long-term disability, and AD&D insurance 401k with employer match Tuition reimbursement program Career development opportunities Referral bonus for all successful full-time referrals Annual opportunities for increases Pay

The pay for this position is $23.

00 an hour. Actual salary is dependent on skills, experience, education, and other business factors. Our Culture BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential. Our culture focuses on three core values:

Collaboration:

working together across 31 locations to achieve the best for the company and our clients

Dedication:

striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues

Integrity:

doing what we say we will do. Upholding strong ethical and moral principles

ADA & EEO

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