PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Whittier Hospital, PIH Health Downey Hospital and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

The ELIGIBILITY SPECIALIST is responsible for verifying PHP Group/IPA HMO members eligibility including coordination of benefits, linking employers groups with benefit products, auditing data in Data Wing Eligibility Manager for auto-load of members into EZ-CAP, reviewing eligibility for Priority UM Referrals/Claims which may require manual data entry of members current enrollment into EZ-CAP, working on various eligibility reports to eliminate duplicate members, correct bad addresses, contact unassigned members to assist with a PCP change; assist with PCP capitation audits/process, support Supervisor with P4P reports and provide support to IPA PCPs/others as necessary; with an emphasis on front-line eligibility problem solving.

Required Skills

• Excellent communication skills
• Attention to detail
• Great customer service skills
• Organizational skills
• Problem solving
• Data entry
• Team oriented
• Ability to function in a fast-paced environment

Required Experience

• MUST HAVE A HIGH SCHOOL DIPLOMA OR G.E.D.
• Two (2) years previous work experience in a Managed Care environment is REQUIRED

Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package.  We are an equal opportunity employer and seek diversity in our workforce.   EOE M/F/D/V

• Excellent communication skills
• Attention to detail
• Great customer service skills
• Organizational skills
• Problem solving
• Data entry
• Team oriented
• Ability to function in a fast-paced environment