Eligibility Specialist at Leading Edge Administrators LLC

Egypt Lake-Leto, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

15 Jun, 26

Salary

0.0

Posted On

17 Mar, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Eligibility Processing, Enrollment, Data Validation, HIPAA Compliance, Data Analysis, Root-Cause Analysis, Vendor Interface, System Access Management, Time Management, Organizational Skills, ID Card Creation, Auditing, Data Transfer, Problem Solving, Attention To Detail, Communication

Industry

Insurance

Description

Description Job Summary: The Eligibility Specialist will process benefit entries and validate information. This role will respond to eligibility and other enrollment related issues involving member specific information; partner directly with clients, and/or vendors, to resolve problems and achieve positive outcome. Duties and Responsibilities: Perform eligibility additions, terminations, and changes for new and renewal clients from electronic files, paper forms and portal. Confirm that enrollments or changes are made according to legal or client specifications. Validate enrollments to ensure that they are activated timely, and that information is correctly and completely entered. Verify that information needed for data transfer to affiliated vendors is included. Stay informed about current and evolving regulations impacting the insurance industry, including, but not limited to, state insurance codes, federal regulations (e.g. HIPAA) and other relevant laws to ensure compliance rules are strictly followed. Provide feedback on implementations and renewals for eligibility processing to improve processes, workflows, and products. Interpret and analyze data from multiple sources including claims, provider, member, and encounters data. Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customers. Interface with providers, vendors, and internal departments to address billing or technical issues related to eligibility. Create and maintain system access logons for Brokers and Clients. Receive and respond to inquiries and data transfers from clients meeting department turn-around time for responses and queue levels. Support team with review of system configuration and processes to ensure optimum processing. Manage multiple deadlines associated with differing tasks using proficient time management and organizational skills. Create ID cards for new and renewal business ensuring that the templates are built completely and accurately. Release ID Cards timely and report any backlogged cards or issues to management immediately. Audit and validate ID card processing ensuring released cards meet end user expectations and template requirements. Generate and mail required notices for all product lines. Requirements Required Knowledge, Skills, and Abilities: High school diploma or equivalent 2 years of experience in eligibility, enrollment, ID card configuration or benefits customer service role focused on eligibility Knowledge of health insurance plans and employee benefits Experience with benefit administration platforms such as Javelina preferred Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint Ability using a computer which includes expert keyboard and navigation skills and learning new programs Communicate clearly and professionally with internal and external customers Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers Pay close attention to detail in all aspects of the job Make decisions using available resources and sound judgment Maintain confidentiality and discretion Identify and resolve problems in a timely manner, gather and analyze information skillfully Share knowledge with associates by effectively communicating and providing follow-up Open to other’s ideas and exhibits a willingness to try new things. Demonstrate accuracy and thoroughness; monitor work to ensure quality. Prioritize and plan work activities to use time efficiently. Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events. Follows instructions, responds to direction, and solicits feedback to improve. Act in such a way to instill trust from management, other associates, as well as customers. Work overtime as required, including evenings and weekends as business needs dictate. Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions. Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus Occasional: Lift and/or move up to 10 pounds Constant: Regular, predictable attendance is required Constant: While performing the duties of this job, the employee is regularly sitting for the full shift. Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending. Work Environment: The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job. The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate. The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

Responsibilities

The Eligibility Specialist will process benefit entries, validate member information, and handle eligibility additions, terminations, and changes for new and renewal clients from various sources. This role involves interfacing with clients and vendors to resolve enrollment issues, ensuring compliance with regulations, and performing data analysis on multiple data sources.