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Electronic Eligibility Analyst Jobs (NOW HIRING)

CVS Health

Eligibility Consultant - Paper Ops

$17 - $34.15/hr

Maintains enrollment databases and coordinates transfer of non-electronic eligibility data ... Ability to analyze and research data to make appropriate corrections as necessary. * Strong verbal ...

ADP

Business Operations Analyst

Miami, FL · On-site

Benefits Operations Analyst I The Benefits Billing Recon and Eligibility team is responsible for a ... Eligibility related responsibilities include the administration of the Electronic Data Interface ...

ADP

Business Operations Analyst

Miami, FL · On-site

Benefits Operations Analyst I The Benefits Billing Recon and Eligibility team is responsible for a ... Eligibility related responsibilities include the administration of the Electronic Data Interface ...

Florida Jobs

ELIGIBILITY SPECIALIST I

Largo, FL · On-site

The work performed includes processing data from electronic sources and entering information into a ... Analyze and interpret written, numerical, and verbal data from various sources. Enter data ...

Florida Jobs

ELIGIBILITY SPECIALIST I

Sarasota, FL · On-site

The work performed includes processing data from electronic sources and entering information into a ... Analyze and interpret written, numerical, and verbal data from various sources. Enter data ...

Florida Jobs

ELIGIBILITY SPECIALIST I

Orlando, FL · On-site

The work performed includes processing data from electronic sources and entering information into a ... Analyze and interpret written, numerical, and verbal data from various sources. Enter data ...

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Electronic Eligibility Analyst information

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How much do electronic eligibility analyst jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for electronic eligibility analyst in the United States is $22.65, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $25.96 per hour, depending on experience, location, and employer.

What is an electronic eligibility analyst?

An Electronic Eligibility Analyst is a professional who reviews, analyzes, and manages electronic data related to eligibility for programs such as health insurance or government benefits. They ensure that electronic records are accurate, up-to-date, and comply with relevant policies and regulations. Their responsibilities include processing eligibility files, resolving discrepancies, and collaborating with other departments to improve the efficiency of eligibility determinations. This role often requires strong analytical skills, knowledge of relevant software systems, and an understanding of data privacy requirements.

How does an electronic eligibility analyst typically collaborate with other departments to resolve eligibility discrepancies?

Electronic Eligibility Analysts frequently work with HR teams, IT staff, and benefits administrators to ensure member data is accurate and up-to-date. When discrepancies arise, analysts may coordinate with these departments to verify information, update records, and clarify policies or plan requirements. Effective communication and strong problem-solving skills are essential, as the role often involves troubleshooting system errors and explaining complex eligibility rules to non-technical colleagues. This collaborative environment helps ensure seamless benefits administration and a positive experience for members.

What are the key skills and qualifications needed to thrive as an electronic eligibility analyst, and why are they important?

To thrive as an Electronic Eligibility Analyst, you need a solid understanding of health insurance regulations, eligibility processes, and data analysis, often supported by a degree in health informatics, business, or a related field. Proficiency with eligibility management systems (such as EDI 834 files), data analysis tools, and healthcare information software is typically required. Attention to detail, problem-solving abilities, and strong communication skills are vital soft skills for success in this role. These competencies ensure accurate eligibility determinations, compliance with regulations, and effective collaboration across teams and stakeholders.

What is the difference between Electronic Eligibility Analyst vs Insurance Verification Specialist?

AspectElectronic Eligibility AnalystInsurance Verification Specialist
CredentialsTypically requires healthcare or insurance-related certifications, such as CPC or HCCOften requires similar certifications, focusing on insurance verification skills
Work EnvironmentWorks in healthcare settings, insurance companies, or billing departmentsPrimarily in healthcare facilities, billing offices, or insurance companies
Employer & IndustryHospitals, clinics, insurance providersHospitals, clinics, insurance companies
Job FocusVerifies patient eligibility electronically, reviews coverage detailsVerifies insurance coverage manually or electronically, confirms benefits

Both roles involve verifying insurance coverage, but Electronic Eligibility Analysts focus on electronic systems and data accuracy, while Insurance Verification Specialists may handle manual verification processes. The roles often overlap in healthcare and insurance settings, with similar credentials required.

What are the most commonly searched types of Electronic Eligibility Analyst jobs?

The most popular types of Electronic Eligibility Analyst jobs are:

What job categories do people searching Electronic Eligibility Analyst jobs look for?

The top searched job categories for Electronic Eligibility Analyst jobs are:

Electronic Eligibility Analyst jobs near you
Infographic showing various Electronic Eligibility Analyst job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, 5% Part Time, and 5% Contract. Highlights an 73% In-person, 11% Hybrid, and 16% Remote job distribution, with an average salary of $47,119 per year, or $22.7 per hour.

Electronic Eligibility Administrator

Hawaii Dental Service

Honolulu, HI • On-site

$17.50 - $23.50/hr

Other

This job post has expired 2 days ago. Applications are no longer accepted.

Job description

Job Title

Under the direction of the Group Service Center Manager, performs duties involving the planning and implementation of electronic transmission and administration of eligibility, internal and external coordination when appropriate as well as training and guidance for clarification and understanding of electronic processes. Builds and maintains customer relationships in a professional manner both internally and externally. Assists the Group Service Center Manager in ensuring the company and departmental objectives and goals are met.

Essential Duties and Responsibilities
  • Under the direction of the Group Service Center Manager, performs duties involving the planning and implementation of electronic transmission and administration of eligibility, internal and external coordination when appropriate, as well as training and guidance for clarification and understanding of electronic processes. Builds and maintains customer relationships in a professional manner both internally and externally. Assists the Group Service Center Manager in ensuring the company and departmental objectives and goals are met.
  • Develops and maintains strong relationships with HDS clients in assisting with enrollment transitions and problem resolution based on the knowledge and understanding of the HDS database system. Determines and recommends the best solutions for electronic enrollment transmission based on the client and HDS's system capabilities. Works to develop high standards for customer relations and service satisfaction of eligibility-related matters, including internal and external training of BESS reports.
  • Monitors and coordinates work with other departments, such as Sales with transitions of new clients, transitions of Third-Party Administrators for existing clients, problem research and resolution; Dental Claims and Customer Service with eligibility research for claims-related inquiries, and ISD with systems and applications enhancements and testing.
  • Manages Daily Task Lists, distribution and assignment of electronic eligibility transaction processing. Monitors workload of transactions of the Group Service Center's daily eligibility activities. Evaluates effectiveness of eligibility processes and procedures and proposes recommendations to the Group Service Center Manager.
  • Assists the Group Service Center team with the design, writing, maintenance and production of departmental manuals, including but not limited to standards of operations, flow chart and user processing manuals.
  • Other Duties and Responsibilities:
    • Assists the Group Service Center Administrator and/or Manager with special projects when necessary.
    • Assists the Group Service Center department in processing daily enrollment activities as necessary once the daily electronic processing is completed and during high volume period or during periods of low staffing.
Minimum Qualifications and Experience

Education

  • Bachelor's degree in Business Administration, Information & Computer Sciences, Management Information Systems or an equivalent combination of education, training or working experience.

Experience

  • Three (3) years progressively responsible office administration experience, preferably in the areas of servicing groups, group contracts and/or customer service.
  • Work experience to include Microsoft suite of applications, with 1-2 years experience with Excel, preferably with advanced spreadsheet features and functions.
  • Knowledge of programming languages such as SQL or language is desirable.

Skills and Knowledge

  • Ability to organize, analyze and problem-solve complex problems.
  • Ability to handle multiple tasks and prioritize with some distractions.
  • Ability to communicate both orally and in writing with all levels of staff, customers, consultants/brokers, and vendors on sensitive matters.
  • Technical knowledge and experience with using computer applications for problem-solving and answering staff questions (prefer Windows, and Word).
  • Ability to focus on detail.
  • Ability to handle all information in a confidential manner and in compliance with federal and state laws/regulations (i.e. HIPAA, PHI).
Work Environment
  • Hybrid, minimum three (3) days in the office.
  • Monday - Friday, weekend and holiday work may be required.

Note: The above information on this description has been designed to indicate the general nature and level of work performed by an employee in this classification. It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications of employees assigned to this job. Hawaii Dental Service has the right to add to, revise, or delete information in this description. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential functions of this position.

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