Eligibility Specialist

15 hours ago


Sacramento, California, United States Bloom Value Full time
Job Summary

Bloom Value Corporation is seeking a highly skilled Eligibility Specialist to join our team. The successful candidate will be responsible for analyzing, reviewing, and overseeing the eligibility lifecycle, ensuring proper loading of all Health Plan eligibility and capitation files, and updating member eligibility as requested.

The ideal candidate will have a strong attention to detail, proficient oral and written communication skills, and the ability to multitask and work in a fast-paced environment. They will also be responsible for developing and maintaining Health Plan relationships, identifying and correcting member addresses from returned mail, and performing all other duties as assigned.

Requirements include an Associate's degree, a minimum of 3 years working in a managed care setting, and proficiency with Microsoft Excel. Experience working in a capacity as an eligibility coordinator or eligibility specialist is also preferred.

Key Responsibilities:

  • Ensuring proper loading of all Health Plan eligibility and capitation files
  • Updating member eligibility as requested
  • Redetermination review with applicable Health Plans
  • Coordinating with Health Plans on needed changes/updates
  • Loading new benefits each year and as needed
  • Analyzing member termination reports and identifying any trends
  • Identifying and correcting member addresses from returned mail
  • All other duties as assigned

Requirements:

  • Associate's degree
  • Minimum of 3 years working in a managed care setting
  • Proficiency with Microsoft Excel
  • Experience working in a capacity as an eligibility coordinator or eligibility specialist

About Bloom Value Corporation:

Bloom Value Corporation is a technology start-up based in Sacramento, CA, USA. We are focused on financial and operational value optimization, and our team has research, development, and consulting experience across a broad range of industries and provider institutions.

We are developing a unique AI platform for Healthcare Finance and Operations Optimization, enabling Healthcare C-suite to gain full glass box visibility, benchmarking, exception management, and proactive optimization across multiple areas of healthcare finance.



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