| Eligibility Processor (Troy, MI) Summary – The Eligibility Processor will review and process eligibility inquiries as well as determine, maintain, and terminate member and/or dependent eligibility for healthcare benefits. Processors provide support to the healthcare service team, supervisors, and manager, when necessary. Essential Duties and Responsibilities include but not limited to - Understand the plan rules for eligibility as outlined in the Summary Plan Description (SPD)
- Process month end reporting
- Use reports to determine eligibility, reinstatement, or termination of coverage
- Prepare & mail enrollment packages and ID cards for newly eligible members
- Review calc reports and exception reports to update eligibility, as needed
- QA self-payment notices, COBRA notices, status slips, member/dependent letters to ensure accurate information and timely mailing to participants
- Processing eligibility documents in OnBase for clients
- New member forms
- Vital information forms
- Medicare information forms
- Other insurance information forms
- Member/dependent PHI
- ACH authorization
- Death notifications
- Qualified Medical Child Support Order (QMSCO)
- Eligibility appeals
- Loss of time credits
- Enrollment escalation requests (call center resolution form)
- Vendor file approvals
- Vendor discrepancy reports
- Evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules
- Process payments for health & welfare coverage
- Request missing information from members
- Process eligibility escalations within 24 hours and call back members with updates, as needed
- Work with the pension department to ensure H&W deduction amounts are correct and properly set up for retired members and surviving spouses
- Responsible for class code and coverage changes when member’s status changes, such as adding/terming dependents, disability, retirement, or death
- Understand Medicare rules and regulations to determine eligibility for Medicare benefits and update coordination of benefits in appropriate systems
- Verify and maintain employee demographic information, such as member or dependent address, contact numbers, birth date, social security number, or MBI number
- Comment system with appropriate updates based on documentation received
- Review and approve any plan changes, such as H&W rate changes, eligibility rule changes, or benefit changes with a vendor
- Meet daily/weekly quota requirements set by management team
- Update Redbook when necessary; within 24-48 hours of change notification
- Be knowledgeable of policies, procedures, and coverage of various funds
- Regular and predictable attendance is an essential function of this job
Qualifications - Excellent multi-tasking skills are a must. Preferred Qualification - Spanish speaking. Education and/or Experience – High school diploma or GED and one year of eligibility experience preferred. Language Skills – Must speak clearly and professionally. Ability to understand directions and follow them to completion of requested task. Mathematical Skills – General math skills. Reasoning Ability - Ability to apply common sense to carry out detailed written or verbal instructions. Work Environment - Fast-paced department. Must be able to work independently as well as in a team, must be able to multi-task and detailed oriented. Work Schedule - Full time. Monday - Friday, 7:30am - 4:30pm. Required in office (no at-home days). Competitive Benefits and Compensation Package - 12 paid holidays
- Paid Time Off (PTO)
- Pro-rated during first year of employment
- 15 days of PTO provided in the next calendar year!
- 3 days paid bereavement
- Up to 20 days paid jury leave
- Medical, dental, and vision insurance, with option for dependent coverage
- Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
- 401k with employer match
- Tuition reimbursement program
- Career development opportunities
- Referral bonus for all successful full-time referrals
- Annual opportunities for increases
Pay - The pay for this position is $23.00 per hour. Actual salary is dependent on skills, experience, education, and other business factors. Our Culture BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential. Our culture focuses on three core values: - Collaboration: working together across 31 locations to achieve the best for the company and our clients
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
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