Eligibility Coordinator (Canfield, OH)
Job Posting for Eligibility Coordinator (Canfield, OH) at BeneSys, Inc.
Eligibility Coordinator (Canfield, OH)
Summary – This is a fast paced, call center environment. The primary responsibilities in this position are to answer participant and dependent phone calls regarding eligibility and enrollment as well as determine, maintain and terminate member and/or dependent eligibility for health care benefits.
Essential Duties and Responsibilities include the following, although other duties may be assigned at the discretion of management:
- Answer participant phone calls.
- Know the plan rules for eligibility as outlined in the Summary Plan Description (SPD) for each fund.
- Use month-end reports to determine eligibility, reinstatement and termination of health care coverage.
- Prepare and mail enrollment packages and ID cards to all newly eligible members.
- Carefully review month-end calculation report, exception report, post Health & Welfare (H&W) report and pension check H&W deduction reports.
- Work with Data Entry department to ensure that reported work hours are properly recorded and computed.
- Assist members and their dependents with all issues regarding eligibility for benefits.
- Explain eligibility rules to members.
- Work with pension department to ensure H&W deduction amounts are correct and deducted properly for retired members and widows.
- Audit monthly H&W Pension deduction reports.
- Collect completed enrollment forms and add all members and their eligible dependents to the appropriate BeneSys system and any/all outside vendor systems.
- Request and evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules.
- Review monthly status reports and self-payment notices before mailed to members to ensure information is correct.
- Mail manual self-payment notices to members who receive late hours or make late payments.
- Determine qualifying events and notify member/dependent of COBRA rights.
- Responsible for Class Code and coverage changes when member’s status changes, such as adding dependents, disability, retirement, death and when dependents reach maximum age for coverage.
- Send proper enrollment documents to members adding children or a spouse.
- Requests missing address for members from employers.
- Verify and maintain employee vital information, e. g., member and dependent address, phone number, date of birth and social security numbers.
- Change Class Code for members eligible for Medicare and enter Medicare effective dates and MBI numbers in BeneSys system.
- Enrollment verifications.
- Other insurance inquiries and input.
- Death Notifications.
- Communicate with various vendors regarding prior authorizations and eligibility issues.
- Review and approve weekly and monthly eligibility extracts to be sent to vendors.
- Answer participant calls, mail participant requests and resolve participant issues.
- Identify and report to Programming Department, system errors in work-hour computations.
- Audit vendor reports and invoices on a monthly basis.
- Identify and report discrepancies in vendor invoices and month-end reports to Manager.
- Comment system when changes are made to Participant record or when Participant calls with request.
- Review and approve new Plan changes (rule changes/rate changes) when applicable, after Programming has entered the changes.
- Update Redbook when necessary, within 48 hours of change notification.
- Ensure Client Site has most accurate and up-to-date information for the Fund that he/she has been assigned.
- Is knowledgeable of policies, procedures and coverage of various funds.
- Regular and predictable attendance is an essential function of this job.
Healthcare Service Representative/Eligibility Coordinator Levels
Level I General math skills, displays good customer service skills, experience answering customer phone calls for assigned fund and team. Administration in COBRA, self-payments and status slips, timely vendor file approvals. Ability to handle approximately up to 2,500 member lives. Meeting department standards of 98% accuracy and timely processing. No more than 2 failed desk audits within a 6-month period. Proficient skills in MS Word, Excel and Outlook.
Level II Level I skills. Complete understanding of BeneSys systems and department procedures. Ability to understand and interpret Plan rules. Ability to answer phone calls for all clients. Ability to troubleshoot and communicate issues relating to; BeneSys systems, members and vendors. Ability to train other employees. Ability to handle approximately 2,500 to 5,000 member lives.
Level III Level I and II skills. Ability to handle 5,000 member lives. Complete understanding of all clients, assist and resolve escalated issues and member calls. Experience with eligibility processes on all software platforms; Legacy, BenefitDriven, OnBase, etc. Troubleshoot issues related to vendors and eligibility EDI files. Ability to assist with open enrollment, rate, and vendor changes. Creates IT helpdesk tickets for their assigned fund and those on their team. Participation in Get Well Plan conference calls.
Supervisory Responsibilities – None
Qualifications – Excellent customer service skills are a must. Proficient in the use of Word, Outlook and Excel.
Education and/or Experience – Post-High School education or prior related work experience preferred.
Language Skills – Good oral and written communication skills. Ability to read and interpret: the eligibility rules as outlined in the SPD; user manuals for on-line services; department rules and procedures manual; and COBRA Compliance manual. Ability to speak clearly and effectively explain to members, dependents, providers and union officials the month-to-month eligibility rules and requirements for coverage.
Mathematical Skills – General math skills with the ability to calculate hours and rates to determine self-payments and hour banks.
Reasoning Ability – Must be capable of thoroughly analyzing vendor invoices and all month-end reports; find discrepancies in member’s eligibility; make necessary corrections based on department procedures; understand Plan rules and analysis of member’s eligibility.
Physical Demands – Must be able to sit for up to eight hours each day answering incoming calls and preparing various correspondence using a variety of office equipment. Must be able to stand for one-to-three-hour intervals while completing filing tasks, organizing department fulfillment center, standing at copy machines to make packages. Occasional lifting of paperwork, eligibility packages, Summary Plan Description boxes. Must be able to move to different workstations as position needs warrant.
Work Environment – Fast-paced department. Phone calls are continuous and occasionally unpleasant. Must be able to maintain composure with difficult callers. Most work is done independently. Must be able to multi-task. Must be detail oriented. May have to manage several projects at one time and may be interrupted frequently to meet the needs and requests of multiple clients. The environment is busy, noisy and requires excellent organizational, time, and stress-management skills to complete the required tasks.
Work Schedule
Full Time, 7:30am - 4:30pm. Required in office (no at-home days).
Competitive Benefits and Compensation Package
- 15 days Paid Time Off (PTO) during first full calendar-year of service
- 12 paid holidays
- 3 days paid bereavement
- Up to 20 days paid jury leave
- Medical, dental, and vision insurance, with option for dependent coverage
- Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
- 401k with employer match
- Tuition reimbursement program
- Career development opportunities
- Referral bonus for all successful full-time referrals
- Annual opportunities for increases and bonuses
Pay
Hourly rate ranges from $18.00 - $22.00. Actual rate dependent on location, skills, education, experience and other business factors.
Our Culture
BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
- Collaboration: working together across 31 locations to achieve the best for the company and our clients
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO
Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
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