Eligibility Specialist, PHIEA

2 days ago


Harrisburg, Pennsylvania, United States Commonwealth of Pennsylvania Full time
Job Summary

The Commonwealth of Pennsylvania is seeking a highly skilled Eligibility Specialist to join our team. As an Eligibility Specialist, you will be responsible for handling the day-to-day operations of PHIEA's program eligibility, including evaluations, quality assurance checks, and identifying and resolving issues related to eligibility. This position is also the point of contact for the Customer Escalations and Appeals processes, ultimately improving outcomes for Pennsylvanians who have health insurance needs not met by other minimum essential coverage.

Key Responsibilities
  • Review and analyze medical insurance policies and premiums
  • Respond to inquiries relating to applicable service or benefits in health care insurance programs
  • Perform quality assurance checks and identify and resolve issues related to eligibility
  • Serve as the point of contact for Customer Escalations and Appeals processes
Requirements
  • Four years of experience in the review and analysis of medical insurance policies and premiums
  • Bachelor's degree in Business Administration, Business Management, Healthcare Administration, Operations Management, Information Systems, or a related field
  • Pennsylvania residency is required
Preferred Qualifications
  • Strong written and verbal communication, time management, and presentation skills
  • Experience with Affordable Care Act (ACA) federal or state-based exchanges and/or Health Insurance companies


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