Eligibility Specialist

Bridge Specialty Group•Clearwater, FL

About The Position

One80 Intermediaries is seeking an Eligibility Specialist to administer enrollment and eligibility functions across a multi-system infrastructure, including imports, exports, eligibility workflows, and support for ecommerce sales. The role requires understanding the architecture of QicLink and NewWave information systems and their external and internal interfaces. The specialist works with internal and external constituents to retrieve, import, export, and analyze enrollment data in various formats, and performs analysis, troubleshooting, and error correction. The position supports enrollment and eligibility processes across product lines, helping ensure benefits are administered accurately and on time for claims and customer service. The specialist works with internal partners and external clients or vendors, resolves discrepancies, documents processes and business rules, and identifies opportunities for improvement. The role collaborates with I.T., Client Services, Accounting, Claims, and Executive Management to deliver responsive and effective outcomes in a fast-paced, deadline-driven environment.

Requirements

Comprehensive understanding of related operational support processes.
Strong planning and organizing skills.
Advanced software skills in MS Word, Excel, Outlook, TextPad/TXT, and reporting specifications.
Ability to use Secure FTP and encryption.
Ability to work in a fast-paced, deadline-driven environment.
General knowledge of manual and automated eligibility.
Competent use of available reporting tools.
Technical understanding of systems and working knowledge of company infrastructure.

Responsibilities

Implement and maintain enrollment and eligibility records across product lines in support of claims and customer service.
Implement, update, and maintain automated, user-portal, and manual eligibility data.
Interact with internal partners and external clients or vendors.
Generate reports to identify and resolve discrepancies and monitor headcount variations.
Document processes, enhancement requests, user guides, and business rules.
Identify process improvement opportunities and provide ongoing input on improvements.
Resolve eligibility discrepancies with clients.
Ensure data is installed accurately and on time.
Develop and manage project work plans through project completion.
Work with I.T., Client Services, Accounting, Claims, and Executive Management to ensure responsive, timely, and effective outcomes.
Prioritize implementation assignments to complete eligibility processes for new accounts accurately and on time.
Coordinate the flow of eligibility information between departments.