Benefit Eligibility Auditor
TX Health Benefits Pool
full-time
Posted on:
Location Type: Office
Location: Austin • Texas • United States
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About the role
- 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.
Requirements
- Graduation from an accredited four-year college or university with major coursework in business administration, insurance, or a related field is generally preferred.
- Two or more years of experience interpreting and applying Section 125 rules and analyzing benefits data.
- Advanced knowledge of benefit terminology and TXHB benefits design.
- Expert knowledge of eligibility requirements including Section 125 rules.
- Knowledge of COBRA, FMLA, and leave administration practices.
- Strong knowledge of MS Office and billing and enrollment software.
- Advanced Excel skills.
- Familiarity with Quality Assurance procedures and standards in a Billing and Eligibility environment.
- Ability to make independent decisions and draw conclusions from data and trends.
- Ability to write reports and correspondence.
- Ability to document procedures.
- Strong service-oriented communication skills.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
benefit plan eligibility auditsinterpreting Section 125 rulesanalyzing benefits dataeligibility requirementsCOBRAFMLAbilling and enrollment softwareadvanced Excel skillsQuality Assurance proceduresdocumenting procedures
Soft Skills
independent decision makingcommunication skillsservice-orientedreport writingguidance provisionorganizational skillsinvestigative skillsliaison abilitieseducational skillsleadership