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SPECTRAFORCE · 5 days ago
Eligibility/Enrollment Representative
United States
Contract
Remote
Entry Level
$19.49/hr - $19.49/hr
1+ years exp
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Hiring Manager
Ankit Soni
Insider Connection @SPECTRAFORCE
Responsibilities
Delivers basic technical, administrative, or operative Eligibility tasks.
Implements and maintains eligibility for benefits.
Implements, updates, and maintains automated, direct connect and/or manual eligibility data by keying information into the system.
Interacts with internal partners and/or external clients/vendors.
Analyzes data and reconciles eligibility for accuracy.
Researches and resolves problems.
Escalates difficult issues.
Strong data entry and customer service skills.
General product knowledge.
Understands simple instructions and procedures.
Performs Eligibility duties under direct instruction and close supervision.
Work is allocated on a day-to-day or task-by-task basis with clear instructions.
Entry point into professional roles.
Responsible for determining plan eligibility and enrolling members within CMS regulatory guidance.
Work to save members with incorrect/incomplete applications by performing customer, physician and/or agent outreach and using support tools.
Maintain member demographic update and membership revalidation and apply eligibility requirements for membership changes.
Research and respond to eligibility inquiries as needed.
Ensures all enrollment eligibility is reconciled and maintained in accordance with CMS and departmental guidelines, requirements, regulations, policies, and procedures.
This position involves reviewing incoming applications, keying information into systems, determining eligibility, and saving submissions as needed.
Phone calls to potential customers and Medicaid systems will be made as needed throughout the day.
In addition to phone calls, Medicaid websites will be reviewed to gather additional information and eligibility verification on enrollees.
Qualification
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Required
1-2 years of healthcare experience required
Experience with Medicare and state Medicaid is highly preferred
Candidates with enrollment or eligibility experience will take priority
Proficient with Microsoft Office suite products
Advanced PC Skills required
Strong attention to detail
Critical thinking
Ability to work with minimal supervision
Excellent verbal and written communication skills
HS Diploma required
Preferred
1-2 years of data entry and enrollment/eligibility experience highly preferred
Benefits
Health benefits
Dental insurance
Vision insurance
Accident insurance
Critical illness insurance
Voluntary life insurance
Hospital indemnity insurance
Commuter benefits
401K plan with matching
Referral bonus program
Unpaid leave
Paid sick leave
Company
SPECTRAFORCE
Welcome to SPECTRAFORCE, your gateway to NEWJOBPHORIA™! Established in 2004, SPECTRAFORCE is now one of the largest and fastest growing U.S.
1,001-5,000 employees
H1B Sponsorship
SPECTRAFORCE has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Trends of Total Sponsorships
2023 (1)
2022 (2)
2021 (5)
2020 (15)
Funding
Current Stage
Late StageCompany data provided by crunchbase
