Eligibility & Enrollment Processor 2

Zenith American Solutions•Oak Brook, IL

4d•$16 - $23

About The Position

The Eligibility & Enrollment Processor 2 supports administration of member eligibility and enrollment activities by maintaining accurate records and responding to member and client inquiries. The role applies knowledge of assigned benefit plans to research and resolve eligibility issues and ensure accurate processing of enrollment information. It contributes to effective customer service and coordinates with internal teams and external vendors to maintain accurate member coverage. The position has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) as defined by the job description and role. The position is in the Technical Operations department, is covered by UFCW 1546, and is classified as Grade 22. Work takes place in a typical office environment with comfortable, constant temperatures and no objectionable elements. The employee may be subject to interruptions, may need to lift up to 25 pounds, and must be able to work a flexible schedule when workflow requires and meet established attendance and punctuality guidelines.

Requirements

High school diploma or equivalent.
One year working as an Enrollment & Eligibility Processor.
Strong work ethic and team-player mentality.
Highly developed sense of integrity and commitment to customer satisfaction.
Ability to communicate clearly and professionally, both verbally and in writing.
Solid organization skills, strong attention to detail, and listening skills.
Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans, and regulations.
Proficient computer skills, including MS Office tools and applications.
Ability to lift up to 25 pounds.
Ability to have a flexible work schedule when workflow requires.
Meet established attendance and punctuality guidelines.

Nice To Haves

Experience working in enrollment administration, benefits administration, or health plan operations.
Experience working with administrative or enrollment management systems.

Responsibilities

Maintain current knowledge of assigned benefit plans and apply plan provisions when performing enrollment and eligibility functions.
Respond to and document telephone, written, and in-person inquiries in accordance with the applicable plan benefits.
Maintain member and dependent files in the administration system to ensure accurate enrollment information.
Resolve eligibility and enrollment issues with vendors, including Preferred Provider Organizations (PPOs) and Pharmacy Benefit Managers (PBMs).
Handle inbound and outbound correspondence, including identification cards, eligibility packets, and related enrollment documentation.
Research and resolve complex and technical issues and irregularities.
Respond to inquiries from examiners and billing processors related to enrollment issues.
Perform other duties as assigned.