Eligibility Specialist III
Posted on Mar 22, 2019 by Beacon Health Options
We are currently seeking a dynamic Eligibility Specialist III to join our team in Latham, NY! The Eligibility Specialist III performs all functions related to membership file load submissions.
About the Position
We are currently seeking a dynamic Eligibility Specialist III to join our team in Latham, NY! The Eligibility Specialist III performs all functions related to membership file load submissions, reviews/verifies member eligibility and ensures member eligibility is accurately represented in the Connect Administration System (CAS) for all clients across all divisions. The incumbent interacts with clients, internal/external client contacts and business systems analysts to investigate and resolve complex eligibility issues. The incumbent also trends and identifies membership anomalies.
- Perform all functions related to membership file load submissions sent via electronic transfer to CAS. This includes running the files, sending reports, confirming completion of files with the client/vendor and working error reports as indicated in the client guidelines.
- Monitor file load retrieval and maintain file load calendar to ensure that all expected files are retrieved timely by the Eligibility Media Scheduler and uploaded from FileConnect to CAS. If files are not received timely the Analyst will perform outreach to the appropriate parties to determine the cause of the delay.
- Review and resolve eligibility errors from the file load process (error recycle) and analyze errors for trends. Research the root cause of errors and proactively report issues and possible solutions if applicable to Management.
- Perform membership analysis within clients and across clients looking for abnormal fluctuation in membership and report anomalies to Management and/or the Business Systems Analyst.
- Complete complex membership projects received from Management.
- Assist when needed in responding to eligibility inquires and working manual updated as needed to ensure that all internal and contractual performance expectations are met.
- Implement assumed eligibility clients which includes creating a Group Request Form and working with the Account Executive to complete the requirements for the group(s), initiating and assisting with the completion of the GL code workflow, building the group in CAS, etc.
- Support testing for systems modifications.
- Complete client terminations for assumed eligibility clients following the termination workflow using the date specified in the termination notice. This includes running queries to ensure that all members are terminated after the process is complete.
- Analyze and recommend workflow, procedural, or systematic changes in an effort to increase automation and efficiency.
- Participate in process improvement workgroups.
- Mentor new staff. Assist the Technical Advisor with trainee development, such as, answering questions and providing up training if required. Provide feedback to Management regarding trainee progress.
- Perform other job related duties as dictated by business needs
- Education: High School diploma or GED equivalent required, Bachelor's Degree in Business or related experience is preferred
- Relevant Work Experience: 3 years insurance experience in a Claim, Eligibility and/or Customer Service environment, with a concentration in a technical or analytical position, is required
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
AAP Reporting Location:
NY - Latham
ID (Req #):