Senior Eligibility Consultant

In this role as a Senior Eligibility Consultant you will:

• Process accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production ensuring services and products meet plan sponsor needs

• Collaborate with business partners to understand enterprise initiatives and goals

• Respond to eligibility and other enrollment related issues 

• Partner directly with clients, vendors, internal teams, and/or local claim operation to resolve problems and achieve positive outcomes

• Anticipate and prevent problems and roadblocks before they occur

• Solve complex problems and take a new perspective on existing solutions

• Design, develop, and deliver transitional training processes and procedures to smooth the transition for newly hired employees from formalized classroom training to the department’s production environment; mentor junior team members

• Assist with and/or evaluate recommendations involving eligibility reporting solutions and negotiate with internal/external clients

• Deliver consulting services in support of data discrepancies and/or involving reporting alternatives

Required Qualifications

• 2+ years experience as an Eligibility Consultant

• Proficiency in processing accurate and timely policy and eligibility data, ensuring services and products meet the plan sponsor needs

• Understands intent/end state and operates with minimal guidance to meet that intent/end state

• Ability to manage multiple tasks and shifting priorities

• A team player capable of operating independently when needed

• Provides accurate and timely results

• Delegates and follows up as needed

• Coaches and mentors others

• Ability to manage high work volume and oversee a variety of incoming work flows

Preferred Qualifications

• Industry knowledge

• Enrollment processing experience

Education

• High School diploma, G.E.D. or equivalent experience