Eligibility Specialist

Job Title: Eligibility Specialist

Reports To: Manager of Eligibility

This is a non-exempt position with primary responsibility for handling enrollment and eligibility for SIHO customers. This data entry position is also responsible for assisting employer contacts with needs pertaining to eligibility and providing reports and other information as needed.

• Respond to telephonic, written inquiries, and emails from accounts concerning eligibility issues.
• Assist internal customers concerning eligibility issues.
• Enroll, terminate, and change eligibility information as requested.
• Initiate and handle student certification, tax dependent verification and disabled dependent verification.
• Maintain eligibility audit reports.
• Process enrollment of new groups as assigned.
• Handle terminations of groups as assigned.
• Track ID Card orders and re-order as needed.
• Track eligibility issues and interactions in the membership system.
• Prepare and communicate special reports as required by accounts.
• Develop and maintain statistical data as required.
• Create and mail letters of creditable coverage.

• Expert level computer skills (Microsoft Excel and Word)
• Detail oriented - high accuracy rate and attention to detail
• Demonstrated problem solving and analytical skills.
• Proven organization and time management skills.
• Excellent communications (oral and written) skills.
• Excellent customer service skills
• General knowledge and understanding of health insurance.
• Ability to work at a self-directed pace in a changing, multi-task environment.
• Professional appearance and presence
• Commitment to support and maintain confidentiality in accordance to HIPAA guidelines
• Current PMAS performance evaluation of "3" or higher (for internal candidates)

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.