Enrollment & Eligibility Coordinator

1 month ago

Buffalo, New York, United States Centivo Full time
About the Role

Centivo is seeking a highly skilled Enrollment & Eligibility Coordinator to join our team. As a key member of our organization, you will play a critical role in ensuring the smooth administration of healthcare enrollment and member eligibility processes.

Key Responsibilities
  • Administer daily files, data, updates, and transmissions related to medical plan enrollment and member eligibility.
  • Determine necessary qualifications for enrollment into group medical plans, including verifying coverage rules, coordination of benefits, and handling medical ID card validations.
  • Review system for eligibility, reinstatement, and termination of healthcare coverage.
  • Perform weekly audits for assigned clients using member census data to ensure coverage is accurate and monitor for file feed issues.
  • Identify root cause of enrollment data discrepancies and address with appropriate contacts to resolve.
  • Complete manual enrollment of members into our system when necessary, including obtaining and entering demographic information and providing new member IDs.
  • Manage and validate ID card releases for all groups.
  • Support loading, transfer, and archive of daily ID card print files from our claims record system to our print vendor.
  • Monitor and respond to Eligibility messages and requests received from Member Care/CSM and directly from client contacts.
  • Collaborate with Implementation and Account Management teams on issues related to group and enrollment/COBRA.
  • Work with external carriers/vendors to ensure member eligibility is accurately reflected.
  • Monitor and assist groups in our employer portal.
  • Manage coordination of benefits for members.
  • Monitor and process claims in SDS queue.
  • Request and evaluate legal documents to determine dependent eligibility according to Plan rules.
  • Identify potential claims impact due to eligibility updates.
  • Meet standard performance metrics and SLAs set for the Eligibility team.
Requirements
  • Ability to prioritize and organize own work to meet deadlines.
  • Ability to work within multiple systems/programs to investigate issues.
  • Intermediate Microsoft Excel skills.
  • Strong customer service skills.
  • Strong verbal/written communication skills.
  • Problem-solving and analytical skills.
  • Detail-oriented.
  • Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
  • Strong interpersonal skills, establishing rapport and working well with others.
  • Knowledge of benefit plans, policies, and procedures and understanding of medical terminology.
Preferred Qualifications
  • Experience working with highly automated and integrated claim adjudication systems.
  • Ability to interpret health plan eligibility rules as outlined in the Summary Plan Description (SPD) document.
  • Coordination of Benefits and Medicare knowledge.
  • Experience with Zelis vendor platform/ID card configuration.
Work Environment

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. We are a dynamic and growing organization, and we are seeking a talented Enrollment & Eligibility Coordinator to join our team.

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