Eligibility Operations Specialist
About The Position
We are seeking a highly organized and detail-oriented Eligibility Operations Specialist to serve as the central point of coordination, tracking, and reporting for all eligibility data sources. This role is responsible for ensuring visibility, accuracy, and timely processing of eligibility across multiple intake channels, including EDI, manual spreadsheets, and Employee Navigator. This role is critical during peak enrollment periods where clear tracking, proactive communication, and issue resolution are essential. The ideal candidate thrives in a cross-functional environment, can manage multiple stakeholders, and brings strong analytical and communication skills.
Requirements
- Bachelor’s degree in business, information systems, healthcare administration, or related field - or equivalent experience
- 3+ years of experience in operations, analytics, and/or project support roles
- Strong organizational and project tracking skills
- Excellent communication and stakeholder management abilities
- Experience working with external vendors or partners
- Proficiency in Excel (or similar tools) for tracking and reporting
Responsibilities
- Eligibility Tracking & Reporting
- Maintain a centralized view of all eligibility activity across EDI feeds, manual spreadsheet submissions and Employee Navigator
- Develop and deliver regular status reports and dashboards for internal stakeholders
- Track group-level eligibility status, file activity, and completion progress
- Identify risks, delays, and discrepancies across all intake channels
- Source of Truth & Visibility
- Serve as the single source of truth for eligibility status across all groups and intake methods
- Ensure leadership and internal teams have clear, accurate, and timely visibility into eligibility readiness
- Standardize tracking and reporting across all eligibility sources
- Cross-Functional Coordination
- Act as the primary liaison between internal teams, brokers, EDI vendors, and platform partners (e.g., Employee Navigator)
- Coordinate onboarding, changes, and issue resolution across all eligibility sources
- Ensure consistent communication and alignment across stakeholders
- Peak Season Readiness
- Drive enhanced tracking, reporting, and communication during critical enrollment periods
- Monitor high-priority groups across all intake channels
- Ensure timely processing and readiness of eligibility data
- Act as the central coordination point for escalations and status updates
- Issue Management & Resolution
- Track and manage eligibility-related issues across EDI, spreadsheets, and Employee Navigator
- Partner with internal teams and external partners to resolve discrepancies and data issues
- Ensure timely follow-up and closure of outstanding items
- Process Improvement & Standardization
- Identify opportunities to improve eligibility intake, tracking, and reporting processes
- Help standardize workflows across different eligibility sources
- Support implementation of tools and processes that improve efficiency and visibility
Benefits
- 5% annual bonus based on company profitability
- Affordable health, vision, and dental insurance for you and your family
- Company contributes up to $2,300 to Health Savings Account annually
- Wellness program that contributes additional money towards your HSA
- Automatic 3% contribution into retirement plan
- Career development and growth opportunities
- Flexible Time Off & 10 paid holidays per year
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
