Eligibility Specialist

3 weeks ago


New York, New York, United States State of Pennsylvania Full time
Job Summary

We are seeking a highly skilled Eligibility Specialist to join our team at the State of Pennsylvania. As an Eligibility Specialist, you will play a critical role in handling the day-to-day operations of our program eligibility, including evaluations, quality assurance checks, and identifying and resolving issues related to eligibility.

Key Responsibilities
  • Review and analyze medical insurance policies and premiums to ensure compliance with program requirements
  • Respond to inquiries from customers regarding applicable services or benefits in healthcare insurance programs
  • Identify and resolve issues related to eligibility, including quality assurance checks and customer escalations
  • Work closely with customers to resolve issues and provide excellent customer service
  • Stay up-to-date with changes in healthcare laws and regulations to ensure compliance
Requirements
  • Four years of experience in the review and analysis of medical insurance policies and premiums, or a bachelor's degree in a related field
  • Strong written and verbal communication skills, with the ability to work effectively with customers and colleagues
  • Ability to work in a fast-paced environment and prioritize multiple tasks and deadlines
  • Knowledge of healthcare laws and regulations, including the Affordable Care Act
Preferred Qualifications
  • Experience working with Affordable Care Act federal or state-based exchanges and/or health insurance companies
  • Strong analytical and problem-solving skills, with the ability to identify and resolve complex issues
  • Ability to work independently and as part of a team, with a strong commitment to customer service
What We Offer

We offer a competitive salary and benefits package, including health insurance, retirement savings, and paid time off. We are committed to providing a positive and inclusive work environment, with opportunities for professional growth and development.



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