Eligibility Specialist I

Job Description:

The Eligibility Specialist I is an entry-level position that will work closely with the Eligibility Trainer and be mentored by an Eligibility Specialist II to learn all aspects of Eligibility. The Eligibility Specialist I will assist in a book of business including but not limited to: enrollment/eligibility and will perform all Eligibility Specialist duties under close supervision.

 Key Result Areas 

• Assists with enrollments and billings on assigned groups.
• Processes enrollments, new eligibility, updates and changes, for employees and dependents.
• Assists in communications with clients for questions/concerns on enrollment or changes.
• Reviews daily reports and monthly billing reports for accuracy and adherence to plan document requirements.
• Reviews the eligibility section of the plan document.
• Rush-adds employees for RX coverage or coordinate with CSC to updates
• Maintains Call Tracking and Routing within company standards.
• Reviews hot sheets and enrollment special instructions for document management.
• Attends and observes implementation meetings for current and new business.
• Monitors and maintains online enrollment products for accuracy and adherence to plan document specifications.
• Performs filing, online scanning and attaching documentation as needed.
• Assists with ordering, mailing, and processing of administrative documents (ex: HIPAA, COBRA).
• Delivers excellent customer service to internal and external customers.
• Attends department meetings and other meetings as assigned.
• Researches issues as needed.
• Attends Eligibility and COBRA ongoing trainings.
• Performs other duties as assigned or needed.

Experience and Skills:

• High school degree or equivalent.
• Demonstrate analytical skills.
• Work area should be clean and organized in such a fashion that in their absence the work pending there will be easily accessible to other members of the team.
• Maintain high level of detail and accuracy.
• Types 45 wpm, 10-key and computer knowledge.
• Able to demonstrate excellent attendance and punctuality.
• Excellent customer service attitude and professionalism.
• Demonstrate Accuracy, Customer Service, Timely Turn-Around (ACT).
• Exceptional verbal and written communication skills.
• Proficiency using Microsoft Office (Word, Excel, Outlook, etc.).
• Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines.
• Possess a high degree of integrity and discretion, as well as the ability to adhere to both company policies and best practices.
• Ensure compliance with security practices and procedures, including HIPAA and HITRUST standards.
• Ability to efficiently and effectively perform the Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self.
• Protect and enhance the Core Purpose and the Core Values of AmeriBen.

AmeriBen is an Equal Opportunity/Affirmative Action Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.

If you are unable to use our online application process due to a disability, please contact the Human Resources Department at humanresources@ameriben.com.