Eligibility Coordinator

SCAN Health Insurance•Long Beach, CA

1d•Remote

About The Position

The Eligibility Coordinator will maintain SCAN Health Plan's core eligibility system by reconciling, entering, correcting, and deleting member information. This role involves processing member applications, researching eligibility rejections, entering member data into the IKA system, ensuring regulatory compliance, and verifying eligibility using state and Federal websites. The coordinator will also assist coworkers, provide excellent customer service through outbound calls, attend meetings, and represent the department in process improvement teams. Additionally, the role requires maintaining professional and technical knowledge, preparing eligibility reports and member correspondence, and performing daily reconciliations to resolve member eligibility issues. The company is looking for individuals who are curious about AI and its potential to transform operations and member service.

Requirements

High School Diploma or equivalent experience required.
0-3 years of related experience.
Performs work under minimal supervision.
Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
Possesses comprehensive knowledge of subject matter.
Provides leadership, coaching, and/or mentoring to a subordinate group.
May act as a lead or first-level supervisor.
Technical expertise - Basic technical skills for functional area.
MS Office - Word, Excel, Outlook, Teams, PowerPoint experience required.
Problem Solving - Basic problem solving skills.
Communication - Good verbal and written communication and interpersonal skills.
A background check is required.

Nice To Haves

Curious about AI and its power to transform how we operate and serve our members.

Responsibilities

Processes member applications by reviewing data for deficiencies; assigning codes to data; establishing data entry priorities, and resolving discrepancies by using departmental policies and procedures.
Research eligibility rejected transactions by identifying discrepancies and report findings to the appropriate business area.
Enter member data by inputting alphabetic and numeric information into IKA system according to screen format including benefit assignment, group affiliation, and provider selection, billing information, revenue codes and appropriate cross references.
Ensure regulatory compliance by following departmental desktops, policies and procedures, by adhering to state and Federal regulations and requirements.
Verify eligibility for enrollment using state and Federal websites.
Assist co-workers by training, updating processes, and assisting with job duties.
Provide excellent customer services by making a high volume of outbound calls to members to clarify, obtain, and or confirm information needed to successfully complete member’s enrollment request.
Represent the department by attending meetings, trainings, and process improvement teams.
The ability to accurately interpret and explain eligibility and CMS regulations and requirements in person, via email or telephonically.
Complete requests received through Enterprise, Department Inbox, and Department Queue by responding appropriately and in a timely fashion to internal and external customers; by answering telephonic and written inquiries concerning eligibility issues; following department policies and procedures; by professionally representing the department to others.
Maintain professional and technical knowledge by utilizing access to SCAN University on-line trainings, attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Prepare eligibility report mailings by generating, reviewing and distributing eligibility information to providers within defined timelines.
Contribute to team effort by accomplishing related results as needed.
Prepare member correspondence by creating, triggering, printing, reviewing and mailing.
Assure accurate data from regulatory system reply by utilizing Federal systems and other departmental systems to run reports and collect and analyze data for any necessary updates.
Responsible for daily reconciliations, in an effort to resolve member eligibility Issues by analyzing, correcting or updating data received on daily claims error report, unassigned PCP list and Incomplete Queue.
Reconcile discrepancies, between member data and various systems.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base wage range: $17.00 to $22.00 per hour
Internal title: Eligibility Coord
Work Mode: Mostly Remote
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!
A competitive compensation and benefits program
An annual employee bonus program
Generous paid-time-off (PTO)
Eleven paid holidays per year
Excellent Retirement Savings program
A work-life balance
An opportunity to become part of a team that makes a difference to our members and our community every day!