MagnaCare · 3 days ago
Enrollment and Eligibility Specialist
United States
Full-time
Remote
Mid, Senior Level
5+ years expBrighton Health Plan Solutions is a rapidly growing health care enablement company based in New York City. They are seeking an experienced Enrollment and Eligibility Specialist to manage day-to-day enrollment and eligibility processing, ensuring participants are enrolled in the correct health plans and providing support to clients and members.
Health Care
Responsibilities
Case Management: Create, audit, process and update the member and eligible dependents’ profile(s) into the enrollment database & update the database with changes
Data Analytics: Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes
Troubleshoot Enrollment and Eligibility related inquiries from the Clients, Employer Partners, Health Plan Carriers, the COBRA vendor, and Call Center Representatives
Works directly with the Finance team to review, process, and resolve inquiries from the employers and premium related issues: including outreach to employers, the client and State officials --as needed
Contact Employers regarding delinquencies and late file submissions –when applicable
Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of requests from the client, employers, and members
Participate in activities designed to improve customer satisfaction and business performance
Solve problems that are sometimes out of the ordinary and that may require reliance on conceptual thinking. Maintain broad knowledge of client requirements, procedures and key contacts
Support projects and other departments in completing tasks/projects
Other duties as required
Qualification
Required
Ability to work alternate schedules/hours based on the business's need. Our client is on the West Coast. As such, the department's hours are 10am-9pmEST (7am-6pm PST)
Bachelor's Degree preferred or High School diploma / GED (or higher) OR 5-7 years of equivalent working experience
2+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
Knowledge of managed care, labor and commercial carrier enrollment and eligibility procedures including hourly based eligibility and waiting periods
Knowledge of eligibility files and transaction sets a plus
Must be able to process and/or enter sensitive PHI and confidential Financial Information
Proficiency in HIPAA, COBRA, FMLA, LOAs, QLE, PTO regulations and other eligibility related transactions preferred
Knowledge of Medicare/Medicaid Benefits is a plus
Knowledge of Salesforce is a plus
Moderate proficiency with Windows 365 applications, which includes the ability to learn new and complex computer system applications
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Ability to use critical thinking to solve complex problems and identify when to escalate
Excellent attention to detail, analytical, and good problem solver
Excellent attendance, punctuality and work performance record required
Must maintain a high-level of professionalism and communication skills (written and verbal) at all times
Excellent interpersonal and organizational skills
Must be susceptible to change and change management
Must be a team player that is able to work independently as well
Preferred
Bachelor's Degree preferred or High School diploma / GED (or higher) OR 5-7 years of equivalent working experience
Proficiency in HIPAA, COBRA, FMLA, LOAs, QLE, PTO regulations and other eligibility related transactions preferred
Knowledge of Medicare/Medicaid Benefits is a plus
Knowledge of Salesforce is a plus
Company
MagnaCare
MagnaCare, a division of Brighton Health Plan Solutions, has been a leading and trusted Third Party Administrator for over 30 years.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2014-01-20Acquired
Recent News
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