Verify member enrollment status
Make changes to member – demographics, effective and term dates
Addresses a variety of enrollment questions or concerns from the health plan / state
Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
Manually update urgent request received via email from the health plan / state
Work claim inquiries (H03s)
Manually enter temp newborns
Review and manually update all reconciliation reports received from Finance
Responds, researches, and resolves eligibility related issues involving member specific information
Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
Partners with other team functions to coordinate the release of eligibility and benefit plan information.

Customer Service experience.
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
Strong verbal and written communication skills.
Workplace flexibility
ability to adapt to change.
Knowledge of Health Care and/or MCO’s (preferred).
Knowledge of Enrollment (preferred).
Knowledge Medicaid and/or Medicare (preferred).

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access and many other benefits depending on eligibility.

Eligibility Consultant – Paper Operations

Key skills