Eligibility Representative 1

Position Purpose: Processes and maintains eligibility information for routine individual and/or employer groups under direct supervision. Education/Experience: High School Diploma or equivalent required. One year general work experience required. Maintains accurate eligibility records for assigned line of business. Enters system eligibility data on a daily basis, including new enrollees, changes, and cancellations. Conducts periodic audits of group eligibility data. Reconciles group eligibility report to monthly statements. Responds to all written and telephone eligibility inquires from individuals or assigned employer groups. Researches information on subscribers to resolve problems and disputes. Maintains quality and production standards as outlined by the department. Assists with special projects. Performs other duties as assigned Complies with all policies and standards Typical Day in the Role Standard business hours Monday through Friday 8-4:30. Process new enrollments, eligibility changes, and cancellations, review and maintain member eligibility records, respond to member internal inquiries, resolve eligibility discrepancies, complete redetermination for participants due for renewal within 30-60 days, and complete special projects as needed. Candidate Requirements Must haves: •customer service and member engagement skills, with the ability to build trust and communicate complex healthcare information clearly. •Knowledge of Medicaid, Medicare, and dual eligibility. •Ability to educate participants on plan benefits and guide them through decision making without being sales driven. •Excellent communication skills (Phone, email, and documentation) with professional and empathetic approach. •Experience handling high volume outreach calls. •Basic analytical skills to review member data. •Ability to manage time effectively, meet performance metrics, and follow structured workflows. Top 3 must-have hard skills 1Customer Service 2Data Entry 3Flexibility – due to the consistent changes we experience in Healthcare and the current needs for the company.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 4:30 PM
education: High School

Responsibilities

Maintains accurate eligibility records for assigned line of business.
Enters system eligibility data on a daily basis, including new enrollees, changes, and cancellations.
Conducts periodic audits of group eligibility data.
Reconciles group eligibility report to monthly statements.
Responds to all written and telephone eligibility inquires from individuals or assigned employer groups.
Researches information on subscribers to resolve problems and disputes.
Maintains quality and production standards as outlined by the department.
Assists with special projects.
Performs other duties as assigned
Complies with all policies and standards

Skills

• eligibility information
• accurate eligibility records
• periodic audits

Qualifications

• Years of experience: 1 year
• Experience level: Entry Level

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected].

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

Any consideration of a background check would be an individualized assessment based on the applicant or employee's specific record and the duties and requirements of the specific job.