Eligibility Analyst Jobs

Welcome to a team of caring and passionate people who work each day to meet the needs of our members and clients. At Health Benefits, (a subsidiary of Health Care Service Corporation), you will be part of an organization committed to offering custom services to self-funded health benefits plans that manage costs – without compromising benefits – by offering innovative solutions, flexibility, transparency, and customer support. We are now a subsidiary of Health Care Service Corporation, the largest customer-owned insurance company in the United States and a strategic partner of Health Benefits since 2018, giving us access to increased national scale and support. This is an exciting time to join our team and enhance our culture that emphasizes caring, diversity and inclusion, mutual respect, collaboration, and service to our communities.
Health Benefits is seeking an Eligibility Analyst. The Eligibility Analyst is responsible for providing quality service by timely and accurately entering and/or modifying eligibility data in Health Benefits systems according to established procedure and client requirements. This position is also responsible for responding to telephonic, written and electronic inquiries (PMC/web inquires) from employees/members, clients, brokers and co-workers.
In this position, you will be responsible for providing quality service by timely and accurately entering and/or modifying eligibility data in Health Benefit systems according to established procedure and client requirements. This position is also responsible for responding to telephonic, written and electronic inquiries (PMC/web inquires) from employees/members, clients, brokers and co-workers.
Key Accountabilities

• Respond to telephonic, written and electronic inquiries from clients/brokers, employees/members, and co-workers regarding eligibility, DEA and ID Card related issues.
• Maintain assigned eligibility work queues according to Health Benefits procedure and turnaround time expectations.
• Appropriately refer or escalate calls based on customer service procedures and guidelines.
• Audit Dependent Eligibility, when required.
• Process requests for proof of coverage.
• Follow-up regularly on outstanding issues to ensure timely resolution and client satisfaction.
• Based upon the client’s requirements and methods of eligibility submission, review, interpret, enter, process and/or audit enrollments, terminations and eligibility change requests in a timely and accurate manner utilizing any Health Benefits systems.
• Thoroughly and accurately document all inquiries following Health Benefits guidelines.
• Research inquiries and respond appropriately.
• Request ID Cards and distribute as required.
• Review and resolve eligibility error and audit reports.
• Other duties as needed/assigned.
• Treat all inquiries professionally and respectfully following Health Benefits guidelines.
• Work with Team Leader and/or Technical Eligibility Analyst to resolve electronic eligibility and Real Time Eligibility issues.

Minimum Requirements

• Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
• High School diploma or GED equivalent
• Exceptional data entry skills with high attention to detail
• Ability to work in a fast-paced, customer service and production driven environment
• Effective verbal and written communication skills
• Flexible; open to continued process improvement
• Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word
• Ability to work effectively with team members, employees/members, providers, and clients

At Health Benefits, you will be part of an organization committed to offering meaningful benefits to our associates to support their life outside of work. From health and wellness benefits, 401(k) savings plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, new parent paid leave, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time associates.
The compensation range for this Eligibility Analyst role is $15.00 to $26.90. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan.
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran, or disability.
Required Skills
Required Experience