Eligibility Enrollment Specialist I /Grade 5

Job Title Primary Responsibilities: Verify the loading new member or group data into the enrollment database & update the database with changes Responding to member eligibility or group questions & verify enrollment status Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes Inventory control of member and group transactions Support the Eligibility Call Center Representatives Ability to work with various types of member communication Working with our IT department to investigate and validate member eligibility Works directly with the Accounts Payable team to review and resolve any premium issues including outreach to members, clients and State officials as needed Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of customer requests. Participate in activities designed to improve customer satisfaction and business performance. Use decision-support tools to answer questions, where needed. Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking. Work is frequently completed without established procedures Maintain broad knowledge of client requirements, procedures and key contacts. Support projects and other departments in completing tasks/projects Other duties as required. Essential Qualifications: Ability to work alternate schedules/hours based on the business's need. Bachelor's Degree preferred or High School diploma / GED (or higher) OR 10+ years of equivalent working experience 2+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties Knowledge of managed care, labor and commercial carrier enrollment and eligibility procedures including hourly based eligibility and waiting periods. Prior experience with premium billing and reconciliation, knowledge of 834 eligibility files and transaction sets a plus. Fluent in COBRA, FMLA, QLE's and other eligibility related transactions a plus Moderate proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product Ability to work independently

Created: 2026-03-05