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, 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.
Summary: The Technical Eligibility Analyst is responsible for providing quality service by timely and accurately entering and/or modifying eligibility data, both manually and via the loading of electronic data interchange (EDI) files in TMK-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.
Responsibilities Include:
- 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 TMK Health Benefits system, e.g. PowerSTEPP, Real Time Eligibility/portal, Triple E reports, COBRA Eas.
- Review and resolve eligibility error and audit reports.
- Maintain assigned eligibility WorkQueues according to TMK Health Benefits procedure and turnaround time expectations.
- Resolve eligibility issues, errors, discrepancies.
- Request ID Cards as required.
- Process requests for proof of coverage
- Audit Dependent Eligibility, when required.
- Processes COBRA continuation paperwork for COBRA qualified benefits as well as ongoing account maintenance of the COBRA eligibility in compliance with DOL regulations (14 calendar days)
- Maintains organized records regarding all enrollment activity, both individually and at a client level, including but not limited to Front End Scanning (FES), maintaining trackers, maintaining email records, Group Reference Sheets (GRS), etc.
- Communicate with third party vendors and administrators to update member benefits and coverage information
- Work with Business Analyst to test EDI and other electronic eligibility submissions.
- Write and/or request eligibility reports (WCW and RFCs) and support the testing for any new or modified technology or process.
- Loading EDI files and Error reporting / Discrepancy Report to client / vendor
- Effectively use reference materials such as Reference Sheets and BRS procedures.
- Respond to telephonic, written and electronic inquiries from clients/brokers, employees/members, and co-workers regarding eligibility, DEA and ID Card related issues.
- Treat all inquiries professionally and respectfully following Health Benefits guidelines
- Appropriately refer or escalate calls based on customer service procedures and guidelines.
- Research inquiries and respond appropriately.
- Follow-up regularly on outstanding issues to ensure timely resolution and client satisfaction.
- Thoroughly and accurately document all inquiries using PowerSTEPP, Triple E, COBRA Eas and Family Files following Health Benefits guidelines.
- Other duties as needed/assigned.
Requirements include:
- High School diploma or GED equivalent
- 6 month or more eligibility experience
- Ability to work in a fast-paced, customer service and production driven environment
- Ability to work remotely;
- Secure, reliable high speed internet access
- HIPAA complaint workspace; preferably in a room that can be secured
- Ability to work independently and free from distractions to productivity and accuracy
- Exceptional data entry skills with high attention to detail, strong organization skills and ability to multi-task
- Effective verbal and written communication skills and excellent interpersonal skills
- Ability to work effectively with team members, employees/members, providers, and clients and vendors
- Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
- Flexible; open to continued process improvement, with a positive attitude and willingness to learn
- Knowledgeable in Microsoft Office including Teams, Outlook, Excel, Word and OneNote.
- Demonstrated critical thinking and problem-solving skills
- At least one year of eligibility experience preferred.
- Prior EDI experience (ANSI 834s) a plus.
- Prior experience in a medical office or provider billing environment preferred.
- Prior experience with COBRA, FMLA, LOA and retiree administration/coordination experience preferred.
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.
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The compensation range for this full-time Senior Claims Analyst position is between $17.28/hr. and $32.44/hr. 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