Eligibility Coordinator

POSITION SUMMARY

Coordinates between eligibility products - ASO - Level funded - MEC. Process applications for, changes to, reinstatement of, and cancellation of insurance policies. Duties include reviewing insurance applications to ensure that all questions have been answered, compiling data on insurance policy changes, changing policy records to conform to insured party's specifications, compiling data on lapsed insurance policies to determine automatic reinstatement according to company policies, canceling insurance policies as requested by agents, and verifying the accuracy of insurance company records. Cross training in multiple eligibility products.

ESSENTIAL FUNCTIONS, DUTIES, & RESPONSIBILTIES

The essential functions include, but are not limited to the following:

• Audit and review enrollment forms for accuracy and full completion.
• Calculate appropriate effective dates for which the employee is qualified.
• Correspond with insured or agent to obtain information or inform them of account status or changes.
• Organize and work with detailed office or warehouse records, maintaining files for each policyholder, including policies that are to be reinstated or canceled.
• Review and verify data, such as name, address, date of birth, date of hire, and dependent information.
• Modify, update, and process existing employee records to reflect any change in benefits, amount of coverage, or type of insurance.
• Transcribe data to worksheets and enter data into computer for use in preparing documents and adjusting accounts.
• Notify insurance agent and billing department of retroactive billing changes.
• Calculate premiums, refunds, and adjustments using insurance rate standards.
• Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.
• Compose business correspondence and professional emails for supervisors, managers, and professionals.
• Ensures the accuracy of patient demographic and insurance information, updating as necessary.
• Verifies eligibility and benefits by email.
• Enters insurance and benefit info in WLT software.
• Adheres to HIPAA privacy and confidentiality regulations and guidelines.
• Other duties and tasks may be assigned as appropriate or necessary.

MINIMUM QUALIFICATIONS

• High school diploma or equivalent required.
• 1-2 years of experience in insurance
• Must be familiar with HIPAA eligibility rules
• Proficiency in Outlook, Word, and Excel
• Typing proficiency (minimal errors)
• Must be detail-oriented and able to prioritize work
• Ability to work in the office full-time

TO ALL RECRUITMENT AGENCIES: The Company and its affiliates do not accept unsolicited agency resumes. Please do not forward resumes for any of our job postings, to our careers sites, or to any employees of the Company or its affiliates. We are not responsible for any fees related to unsolicited resumes.