ELIGIBILITY REPRESENTATIVE - Aultman Health Foundation
Canton, OH 44702
About the Job
PURPOSE OF POSITION:
The primary purpose of the Eligibility Representative is for maintaining enrollee eligibility. The Eligibility Representative will accomplish this goal by working as a liaison between the company contacts and the AultCare Sales and Underwriting areas.
RESPONSIBILITIES & EXPECTATIONS:
- Serves as a liaison between AultCare and our Clients’ Benefits Department.
- Maintain initial enrollment, new hires and terminations.
- Handles any enrollment changes.
- Is competent in reading benefit plans and SPD’s/certificates. Must follow the guidelines of the plans and process enrollment accordingly.
- Processes all forms of enrollment: paper, electronic.
- Maintains pertinent information in enrollees’ files to assist the Claims Analyst in processing claims.
- Works closely with other areas in AultCare, such as: Claims, Customer Service, Sales, Underwriting, Billing and Reinsurance.
- Must possess excellent communication skills, both verbal and written.
- Timely mailing of proper letters and correspondence to members and clients.
- Order accurate Identification cards.
- Is quality-oriented and enters accurate information into the QNXT processing system.
- Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
- Seeks supervisory guidance/approval as appropriate.
- All work is quality reviewed by the Eligibility Coordinator. Employees are subject to meeting the departmental quality and productivity goals.
- Subject to frequent interruptions and responsible for prioritizing of work.
- Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
- Promotes and demonstrates professional standards to enhance the development of the department.
- Practices ethical conduct.
- Meets acceptable attendance and punctuality expectations (excluding FMLA)
- Meets acceptable quality and productivity measures as designated by the Member Services department manager.
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not a detailed description of all the work requirements that may be inherent to this position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.
AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such an accommodation.
QUALIFICATIONS:
- Education: High School Diploma or GED required. Two year college education or comparable experience preferred.
- Functions independently with flexibility, integrity, and the ability to work effectively and efficiently with all levels of personnel.
- Possesses good interpersonal communication skills and works well with all.
- Experience: Above average typing skills (typing test required). Computer experience is required. Strong public relation skills.
- Must be able to deal with confidential information and maintain it confidentially.
- Must be tactful and exercise sound judgment.
WORKING CONDITIONS:
- Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
- Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.
- Sitting/standing/moving about intermittently during working hours.
- Subject to frequent interruptions and changes in priority of duties throughout the day.
PI250578983