MagnaCare · 1 day ago
Eligibility Enrollment Specialist I /Grade 5
Las Vegas, NV
Full-time
Onsite
Entry Level
2+ years expMagnaCare is seeking an Eligibility Enrollment Specialist I who will be responsible for managing member enrollment data and responding to eligibility inquiries. The role involves reconciling discrepancies, supporting call center representatives, and collaborating with various departments to ensure efficient service delivery.
Health Care
Responsibilities
Verify the loading new member or group data into the enrollment database & update the database with changes
Responding to member eligibility or group questions & verify enrollment status
Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes
Inventory control of member and group transactions
Support the Eligibility Call Center Representatives
Ability to work with various types of member communication
Working with our IT department to investigate and validate member eligibility
Works directly with the Accounts Payable team to review and resolve any premium issues including outreach to members, clients and State officials as needed
Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of customer requests
Participate in activities designed to improve customer satisfaction and business performance
Use decision-support tools to answer questions, where needed
Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking. Work is frequently completed without established procedures
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
High School diploma / GED (or higher) OR 10+ 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
Prior experience with premium billing and reconciliation, knowledge of 834 eligibility files and transaction sets a plus
Moderate proficiency with Windows PC 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 work independently
Preferred
Bachelor's Degree preferred
Fluent in COBRA, FMLA, QLE's and other eligibility related transactions 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
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