Eligibility & Enrollment Processor 2

Title: Eligibility & Enrollment Processor 2 Department: Technical Operations
Union: UFCW 1546 Grade: 22

Position Summary

The Eligibility and Enrollment Processor 2 supports the administration of member eligibility and enrollment activities by maintaining accurate records and responding to member and client inquiries.

This role applies knowledge of assigned benefit plans to research and resolve eligibility issues and ensure accurate processing of enrollment information.

The position contributes to effective customer service and supports coordination with internal teams and external vendors to maintain accurate member coverage.

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

Key Duties and Responsibilities


* Maintain current knowledge of assigned benefit plan(s) and applies plan provisions when performing enrollment and eligibility functions.


* Provide customer service by responding to and documenting telephone, written, and in-person inquiries in accordance with various Plan(s) benefits.


* Maintain member and dependent files in the administration system to ensure accurate enrollment information.


* Resolve eligibility & enrollment issues with various vendors, including Preferred Provider Organizations (PPO's) and Pharmacy Benefit Managers (PBMs).


* Handle inbound and outbound correspondence, including identification cards, eligibility packets and related enrollment documentation.


* Researches and resolves complex and technical issues and irregularities.


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


* Perform other duties as assigned.

Minimum Qualifications


* High School diploma or equivalent.


* One year working as an Enrollment & Eligibility Processor


* 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.


* Preferred Qualifications


* Experience working in enrollment administration, benefits administration, or health plan operations.


* Experience working with administrative or enrollment management systems.



*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.

Working Conditions/Physical Effort


* Normal degree of physical effort in typical office environment with comfortab...