Eligibility Specialist

Point C

1d•$19 - $22

About The Position

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

Requirements

1–3 years of experience in benefits administration, eligibility processing, or a related healthcare or insurance environment.
Proficient in Microsoft Office Suite (Excel, Outlook, Word).
Excellent attention to detail, accuracy, and documentation.
Strong organizational and time-management skills.
Effective written and verbal communication skills.
Ability to work independently and collaboratively in a team setting.
High school diploma or GED required

Nice To Haves

Experience in a third-party administrator (TPA) setting is highly desirable.
Familiarity with eligibility systems and EDI file formats preferred.
Working knowledge of HIPAA and ERISA is a plus.
Associate’s or Bachelor’s degree preferred.

Responsibilities

Process eligibility data including new enrollments, changes, terminations, COBRA events, and dependent verifications.
Review and reconcile eligibility files from employers, unions, and payroll systems.
Ensure data integrity by validating input and resolving discrepancies with internal systems and external partners.
Maintain confidentiality and security of personal and health information in accordance with HIPAA regulations.
Respond to eligibility-related inquiries from plan participants, client HR teams, and insurance carriers via phone, email, or secure messaging.
Support monthly and quarterly audits of eligibility data and resolve identified discrepancies.
Coordinate with IT and system vendors to address EDI transmission or interface issues (e.g., FTP transfers, 834 files).
Prepare reports and summaries for internal departments and clients as needed.
Assist with open enrollment, special enrollment periods, and other eligibility-related projects.
Stay up to date on plan changes, legal updates, and industry standards related to benefits eligibility.