Eligibility Coordinators

SUMMARY

Determines and maintains Participant / Dependent Health Care Eligibility. Assisting Participants with eligibility and Open Enrollments, communicating with Health Care providers, etc.

Excellent opportunity to get in on the ground floor of a company that includes employees as part of the team and delivers excellent wages and benefits.

ESSENTIAL DUTIES AND RESPONSIBILITIES including but not limited to :

• Knowledge of Plan eligibility rules as outlined in the SPD for each Plan assigned.
• Review system for eligibility, reinstatement and termination of health care coverage.
• Carefully review Eligibility Calculation exception reports and process all follow-up tasks timely.
• Work with Contributions Department to ensure that reported work hours are properly recorded and computed.
• Review Monthly Benefit Statements for Eligibility accuracy.
• Verify that the deduction amounts are correct for retired members and survivors.
• Verify that all newly eligible members are provided enrollment packets and make sure that the enrollment process is completed.
• Requests and evaluates legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules.
• Reviews monthly status reports and self-payment notices before mailed to members to ensure information is correct.
• Make sure that all self pays recorded in the system are properly allocated to the member record to assure that eligibility is updated daily,
• Determine qualifying events and notify member / dependent of COBRA rights.
• Identifies and reports to Programming Department system errors in work hour computations.
• Audits vendor reports and invoices on a monthly basis.
• Assists members and their dependents with all issues regarding eligibility for benefits. Explain eligibility rules to members.
• Send proper enrollment documents to members adding children or a spouse.
• Process and return dependent QMCSO to court, member and custodial parent.

REQUIREMENTS :

• Must have excellent communication skills
• Must have excellent decision-making, problem-solving, organizational skills and able to work in a team environment.
• 2-4 years of customer service experience
• 2-4 years’ experience in employee benefit plan administration including understanding of health plan eligibility and COBRA administration
• Working knowledge of employee benefit plans and regulations and the ability to explain benefits and claims protocols to others.
• Taft-Hartley experience is a plus
• Ability to read, write and speak Spanish is preferred, but not required
30+ days ago