TX Health Benefits Pool

Auditor

• Performs routine benefit plan eligibility audits including member and dependent eligibility, qualifying life event (QLE), and waiver requests.
• Reviews eligibility rules to determine entitlement to participate in the plan.
• Conducts investigative work to ensure qualifying life events are consistent with changes made.
• Acts as the liaison between TXHB and the customer(s) for all inquiries.
• Documents and manages communication and documentation received.
• Participates in and leads AAW related meetings as needed.
• Audits waiver reasons to ensure appropriate documentation is obtained to support the waiver.
• Educates members on eligibility requirements and audit processes.
• Provides guidance to Benefit Coordinator advocates and other staff as needed.

Benefit Eligibility Auditor