Eligibility Enrollment CSR/Processor

The Enrollment & Eligibility CSR/Processor supports eligibility and enrollment functions, including member inquiries, enrollment processing, and related administrative responsibilities.

Responsibilities

Processing

• Process enrollment & legal documents for all plans
• Process appeals, write summaries, pursue approvals and overturn denials.
• Verify provider credentials and update the database.

Customer Service

• Handle incoming telephone calls and assist members with eligibility, enrollment, benefits, and plan-related inquiries in an efficient, prompt, and professional manner.
• Provide high quality customer service to all Fund members by documenting telephone, written and walk-in inquiries regarding benefits, or claim status.
• Respond to and resolve complex issues, including those escalated by members.
• Serve as primary, daily contact to clients on delivery of services.
• Resolve complex plan provision questions and issues addressed.
• Raise issues as appropriate to Team Supervisor or Department Manager.
• Learn and use professional excellence tools and concepts to ensure efficient and quality output/service delivery.

Teamwork

• Work cooperatively with other team members.
• Actively participate in team meetings and training activities.
• Perform additional responsibilities and projects as periodically assigned.

Education/Certification:

• High School Diploma or equivalent

Skills/Abilities:

• Minimum 40 WPM and 3,000 KPH proficiency
• Ability to maintain current knowledge of all plan’s eligibility & enrollment rules to provide correct information to plan participants and providers.
• Ability to process enrollment and legal documents for all plans.
• Ability to verify provider credentials & update database.
• Ability to process appeals, write summaries, pursue approvals and overturn denials.
• Strong oral and written communication skills with exceptional attention to detail
• Professional, client-focused approach to colleagues and assignments.
• Ability to seek out experiences that may change perspective or provide an opportunity to learn new things.
• Strong dedication to follow-through on all tasks and assignments.
• Ability to sit for long periods of time operating a computer keyboard.

Employee Benefits Program

COMPANY PROVIDES:

• MEDICAL, DENTAL, VISION
• SHORT-TERM DISABILITY
• Full coverage benefits for a low weekly premium of $5 (Employee Only), $15 (for Child(ren) and $20 per week for full family or Employee/Spouse.
• COMPANY PAID supplemental dental coverage of $1,000 per year for Employee.
• COMPANY PAID LONG TERM Disability & Life/AD&D coverage.
• 401K Plan including company match up to 5%
• COMPANY PAID additional pension plan entirely funded by the company.
• EXCEPTIONAL TIME OFF package including Paid Personal Leave (PPL) and Vacation with annual BUY BACK options!!!!
• Annual, automatic pay increases.

Southwest Service Administrators provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disability, genetic characteristics, or any other considerations made unlawful by applicable state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence compensation and training. Southwest Service Administrators expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, pregnancy, military and veteran status, age physical and mental disability, or genetic characteristics.