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Eligibility and Enrollment Advisor
2 months ago
At Centivo, we are dedicated to supporting the workforce and their employers, who are essential to our economy. Our mission is to provide affordable, high-quality healthcare solutions to those facing challenges in managing their healthcare expenses.
We are currently seeking Enrollment & Eligibility Coordinators to become integral members of our team.
As an Enrollment & Eligibility Coordinator, your primary responsibility will be to oversee the daily management of files, data, updates, and communications related to medical plan enrollment and member eligibility. You will also assess the necessary criteria for enrollment in the group’s medical plans, which includes verifying coverage guidelines, coordinating benefits, and managing medical ID card validations.
Key Responsibilities:
Under the supervision of the Enrollment Lead, your duties will include:
- Assessing systems for eligibility, reinstatement, and termination of healthcare coverage.
- Conducting weekly audits for assigned clients utilizing member census data to ensure accurate coverage and monitor file feed discrepancies.
- Identifying root causes of enrollment data inconsistencies and collaborating with relevant contacts for resolution.
- Performing client census reviews for auditing and billing purposes.
- Facilitating manual enrollment of members into our system when required, including collecting and entering demographic data and issuing new member IDs.
- Managing and validating ID card distributions for all groups.
- Supporting the transfer, loading, and archiving of daily ID card print files from our claims record system to our print vendor, ensuring compliance with daily schedules and coordination with the configuration team.
- Monitoring and addressing eligibility inquiries and requests from Member Care/CSM and directly from client contacts through various communication channels.
- Collaborating with Implementation and Account Management teams on group and enrollment/COBRA-related issues.
- Engaging with external carriers/vendors to ensure accurate member eligibility representation.
- Assisting groups in navigating our employer portal.
- Coordinating benefits for members.
- Monitoring and processing claims in the SDS queue.
- Requesting and reviewing legal documents such as divorce decrees, marriage certificates, and birth certificates to assess dependent eligibility in accordance with plan regulations.
- Identifying potential claims impacts due to eligibility changes.
- Meeting performance metrics and service level agreements established for the Eligibility team.
Essential Skills and Competencies:
- Ability to prioritize and organize tasks effectively to meet deadlines.
- Proficiency in navigating multiple systems/programs to troubleshoot issues.
- Intermediate skills in Microsoft Excel.
- Strong customer service orientation.
- Excellent verbal and written communication abilities.
- Analytical and problem-solving skills.
- Attention to detail.
- Demonstrated capability to manage multiple assignments competently and efficiently.
- Strong interpersonal skills, fostering rapport and collaboration.
- Knowledge of benefit plans, policies, and procedures, along with an understanding of medical terminology.
- High school diploma or GED is required; an Associate's or Bachelor's degree is preferred.
- 1-2 years of experience in the healthcare sector is preferred but not mandatory.
- Experience with automated and integrated claim adjudication systems, such as El Dorado-Javelina and/or Health Rules Payer, is advantageous but not essential.
- Ability to interpret health plan eligibility criteria as outlined in the Summary Plan Description (SPD).
- Knowledge of Coordination of Benefits and Medicare.
- Familiarity with the Zelis vendor platform/ID card configuration.
The ideal candidate will be based in a flexible work environment, with options for remote work considered for strong applicants.
Compensation Transparency:
The salary range for this position reflects our anticipated minimum to maximum base salary. Additionally, our comprehensive benefits package includes various components that contribute to total compensation, such as bonuses, health benefits (with some employer contributions), paid time off, and equity options.
Our Core Values:
- Resilience: We recognize the challenges in achieving healthcare affordability and remain committed to our mission, ensuring we persevere through difficulties.
- Innovation: We strive to improve the healthcare system by building better solutions from the ground up, focusing on enhancing experiences for members, employers, and providers.
- Positivity: We support one another, celebrating achievements and providing constructive feedback, fostering a collaborative and uplifting work environment.
Centivo is a forward-thinking health plan designed for self-funded employers, dedicated to delivering affordable, high-quality healthcare solutions. Our primary care-based ACO model enables employers to save significantly compared to traditional insurance carriers, while employees benefit from free primary care services, predictable copays, and no-deductible benefit plans. Centivo partners with employers of varying sizes, from small businesses to Fortune 500 companies.
