Oversee and ensure the accuracy and compliance of eligibility protocols and standards for department processes
Analyze data and conduct verification checks to ensure the accuracy and completeness of all documentation
Create tools, gather data, and conduct analysis in the development of processes to define and measure across the department and multifunctional areas
Lead and assist with new products and services impacting the department
Identify and implement enhancements to processes and systems resulting in operational efficiencies and improvements
Ensure full compliance with relevant regulations, contractual obligations, and internal policies when assessing eligibility data and department processes
Evaluate complex or high visibility cases, identify risk and recommend appropriate measures to manage risk
Collaborate with other departments to address inquiries, clarify eligibility requirements, enhance processes, and resolve concerns
Solve complex problems, take a new perspective on existing solutions, research and respond to eligibility and other enrollment related issues
Identify opportunities to streamline and enhance the eligibility determination process, making key recommendations to management for review
Generate reports and analyze eligibility data to identify trends, patterns, and insights
Develop training materials and conduct training sessions for employees or stakeholders involved in or connected with the eligibility process
Manage assigned projects and ensure project plans and work tasks are in alignment with overall department and organizational goals; manage multiple tasks and shifting priorities
Operate independently and take initiative, anticipate and prevent problems and roadblocks before they occur, provide accurate and timely results

Requirements

3-4 years of operational experience within Eligibility or Healthcare Benefit Administration
Ability to manage high work volume and oversee a variety of incoming workflows, manage multiple tasks and shifting priorities
Provides accurate and timely results, delegates and follows up as needed
Excellent written and verbal communication skills which demonstrate the ability to interact courteously, effectively, and succinctly with a diverse range of stakeholders across business units with both internal and external customers; skills include listening and comprehension, constructive feedback, spelling, grammar, proofreading, and telephone communication
Demonstrated ability to creatively solve problems and create improvements
Possess sound knowledge of Meritain Operational processes (preferred)
Experienced with analytic tools/languages such as SalesForce, Tableau, Access, etc. to analyze large data sets from multiple data sources (preferred)
Ability to successfully interact with members across business units and with external clients (preferred)
Ability to communicate effectively and succinctly with a diverse range of stakeholders, both verbally and on paper, and with all levels of an organization (preferred)

Benefits

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
Confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills

data analysiseligibility protocolsverification checksprocess developmentrisk managementreport generationtraining material developmentproject managementoperational efficiency

Soft skills

problem solvingcommunicationcollaborationinitiativetime managementdelegationlisteningconstructive feedbackadaptability