Eligibility Specialist

Responsibilities:

• Handle high-volume inbound calls and emails related to eligibility, enrollment, and coverage questions
• Process eligibility updates including new enrollments, terminations, and dependent coverage changes
• Verify and maintain accurate participant data, records, and documentation
• Assist with insurance verification, benefits explanation, COBRA, HIPAA, and ACA compliance
• Coordinate with internal teams, IT, and external vendors to resolve data discrepancies and system issues
• Perform system testing and support troubleshooting of eligibility and workflow errors
• Maintain tracking logs for exceptions and ensure timely updates
• Support reporting by gathering and analyzing eligibility data
• Assist with training staff on systems, processes, and workarounds
• Complete administrative tasks including filing, documentation, and compliance support

Requirements:

• Bachelor's degree or equivalent work experience
• Experience in healthcare, benefits administration, or insurance eligibility preferred
• Knowledge of COBRA, HIPAA, ACA, and healthcare eligibility processes
• Strong data entry accuracy and attention to detail
• Ability to manage multiple tasks in a high-volume environment
• Strong analytical, organizational, and problem-solving skills
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office (Excel, Word, PowerPoint); experience with data tools a plus
• Ability to quickly learn new systems and adapt to process changes