Eligibility & Enrollment Processor

Position Summary

The Eligibility & Enrollment Processor supports enrollment operations by maintaining accurate member records and assisting with enrollment-related processes and inquiries.

This role helps ensure enrollment information is processed accurately and that members and stakeholders receive timely support and documentation related to coverage and benefits.

The position contributes to the efficient administration of enrollment activities and supports coordination with internal teams and external partners.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities


* Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.


* Provides written, verbal, or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.


* Maintain member and dependent files in the administration system .


* Resolve eligibility & enrollment issues with the various vendors (PPO'S.PBMs, etc.)


* Handle inbound and outbound correspondence, such as ID cards, eligibility packets, etc.


* Researches and resolves complex and technical issues and irregularities.


* Respond to inquiries from the examiners and billing processors concerning enrollment issues.


* Perform other job related duties as assigned.

Working Conditions/Physical Effort


* Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements.


* May be subject to interruptions.


* May be required to lift a maximum of 25 lbs.


* Must be able to have flexible work schedule when workflow requires.


* Must meet established attendance and punctuality guidelines.

Minimum Qualifications


* High School diploma or equivalent.



* Minimum 6 months general office experience in which candidate has demonstrated dependability.


* Strong work ethic and team player mentality.


* Highly developed sense of integrity and commitment to customer satisfaction.


* Ability to communicate clearly and professionally, both verbally and in writing.


* Solid organization skills with strong detail orientation and listening skills.


* Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.


* Proficient computer skills including MS Office tools and applications



*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job.

Duties, responsibilities and activities may change at any time with or without notice.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of ...