Eligibility Coordinator (Maryland Heights, MO)
Full Time
Maryland Heights, MO 63043
Posted
Job description
Eligibility Coordinator (Maryland Heights, MO)
Summary – Determines, maintains and terminates member and/or dependent eligibility for health care benefits; full time.
Essential Duties and Responsibilities include the following, although other duties may be assigned at the discretion of management:
- Know the plan rules for eligibility as outlined in the SPD for each fund.
- Use month-end reports to determine eligibility, reinstatement and termination of health care coverage.
- Prepare and mail enrollment packages and ID cards to all newly eligible members.
- Carefully review month-end calculation report, exception report, post H&W report and pension check H&W deduction reports.
- Work with Data Entry department to ensure that reported work hours are properly recorded and computed.
- Assist members and their dependents with all issues regarding eligibility for benefits.
- Explain eligibility rules to members.
- Work with pension department to ensure H&W deduction amounts are correct and deducted properly for retired members and widows.
- Audit monthly H&W Pension deduction reports.
- Collect completed enrollment forms and add all members and their eligible dependents to the appropriate BeneSys system and any/all outside vendor systems.
- Request and evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules.
- Review monthly status reports and self-payment notices before mailed to members to ensure information is correct.
- Mail manual self-payment notices to members who receive late hours or make late payments.
- Determine qualifying events and notify member/dependent of COBRA rights.
- Responsible for Class Code and coverage changes when member’s status changes, such as adding dependents, disability, retirement, death and when dependents reach maximum age for coverage.
- Send proper enrollment documents to members adding children or a spouse.
- Requests missing address for members from employers.
- Verify and maintain employee vital information, e. g., member and dependent address, phone number, date of birth and social security numbers.
- Change Class Code for members eligible for Medicare and enter Medicare effective dates and MBI numbers in BeneSys system.
- Enrollment verifications.
- Other insurance inquiries and input.
- Death Notifications.
- Communicate with various vendors regarding prior authorizations and eligibility issues.
- Review and approve weekly and monthly eligibility extracts to be sent to vendors.
- Answer participant calls, mail participant requests and resolve participant issues.
- Identify and report to Programming Department, system errors in work-hour computations.
- Audit vendor reports and invoices on a monthly basis.
- Identify and report discrepancies in vendor invoices and month-end reports to Manager.
- Comment system when changes are made to Participant record or when Participant calls with request.
- Review and approve new Plan changes (rule changes/rate changes) when applicable, after Programming has entered the changes.
- Update Redbook when necessary within 48 hours of change notification.
- Ensure Client Site has most accurate and up-to-date information for the Fund that he/she has been assigned.
- Is knowledgeable of policies, procedures and coverage of various funds.
Level I General math skills, displays good customer service skills, experience answering customer phone calls for assigned fund and team. Administration in COBRA, self-payments and status slips, timely vendor file approvals. Ability to handle approximately up to 2,500 member lives. Meeting department standards of 98% accuracy and timely processing. No more than 2 failed desk audits within a 6-month period. Proficient skills in MS Word, Excel and Outlook.
Level II Level I skills. Complete understanding of BeneSys systems and department procedures. Ability to understand and interpret Plan rules. Ability to answer phone calls for all clients. Ability to troubleshoot and communicate issues relating to; BeneSys systems, members and vendors. Ability to train other employees. Ability to handle approximately 2,500 to 5,000 member lives.
Level III Level I and II skills. Ability to handle 5,000+ member lives. Complete understanding of all clients, assist and resolve escalated issues and member calls. Experience with eligibility processes on all software platforms; Legacy, BenefitDriven, OnBase, etc. Troubleshoot issues related to vendors and eligibility EDI files. Ability to assist with open enrollment, rate, and vendor changes. Creates IT helpdesk tickets for their assigned fund and those on their team. Participation in Get Well Plan conference calls.
Supervisory Responsibilities – None.
Qualifications – To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent customer service skills are a must. Proficient in the use of Word, Outlook and Excel.
Education and/or Experience – Post-high school education or prior related work experience preferred.
Language Skills
– Good oral and written communication skills. Ability to read and interpret: the eligibility rules as outlined in the SPDs; user manuals for on-line services; department rules and procedures manual; and COBRA Compliance manual. Ability to speak clearly and effectively explain to members, dependents, providers and union officials the month-to-month eligibility rules and requirements for coverage.
Mathematical Skills
– General math skills with the ability to calculate hours and rates to determine self-payments and hour banks.
Reasoning Ability – Must be capable of thoroughly analyzing vendor invoices and all month-end reports; find discrepancies in member’s eligibility; make necessary corrections based on department procedures; understand Plan rules and analysis of member’s eligibility.
Certificates, Licenses, Registrations
– None.
Physical Demands – The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work Environment – The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Must be able to sit for up to eight hours each day answering incoming calls and preparing various correspondence using a variety of office equipment. Must be able to stand for one to three hour intervals while completing filing tasks, organizing department fulfillment center, standing at copy machines to make packages. Must be able to move to different work stations as position needs warrant. Occasional lifting of paperwork, eligibility packages, Summary Plan Description boxes. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Fast-paced department. Phone calls are continuous and occasionally unpleasant. Must be able to maintain composure with difficult callers. Most work is done independently. Must be able to multi-task. Must be detail-oriented. May have to manage a number of projects at one time, and may be interrupted frequently to meet the needs and requests of multiple clients. The environment is busy, noisy and requires excellent organizational, time, and stress-management skills to complete the required tasks.
Work Schedule - Monday - Friday, 7:30am - 4:30pm, 1 hour lunch
Competitive Benefits & Compensation Package
- Paid Time Off (PTO)
- 15 days of PTO during the next calendar year!
- Medical, dental, vision, and life insurance
- Company paid short term disability, long term disability, and AD&D insurance
- 401k with employer match
- Tuition reimbursement program
- Career development opportunities
- Referral bonus for all full-time referrals
- Competitive wages
- Annual opportunities for increases and bonuses
Pay
Pay commensurate with education and experience.
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 people want to work, feel proud of what they do and feel fulfilled both professionally and personally; creating 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 and;
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
COVID-19 Considerations
- Daily sanitation procedures in place
- Daily check-in program with rigorous contact tracing
ADA & EEO
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