Eligibility Specialist

Curative - Austin, TX

Full-time

Austin, TX

Personal and Laundry Services

About the position

The Eligibility Specialist is responsible for managing the administrative processing of new enrollments and ensuring the timely and accurate maintenance of client eligibility. This role involves direct interaction with clients and their agents, focusing on accurate reporting and compliance within the account management and implementation departments.

Responsibilities

• Process all transaction types, such as adds, term, changes, group discrepancies and other eligibility related tasks.
• Review and process all manual and/or EDI enrollment transactions (adds, changes, terms) received from clients or internal sources in accordance with Certificates of Coverage and Summary Plan Descriptions.
• Produce electronic spreadsheets and/or reports for audit and processing purposes.
• Research and correct escalated billing issues.
• Perform full reconciliations on accounts to confirm that the group is in compliance.
• Meet established processing cycle time standards and production due dates.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and increase quality of work.
• Track and Trend enrollment data for CQI.
• Be a liaison to Curative overall on industry and market demands to impact process, product, and tech development, along with any process improvements.

Requirements

• Outstanding organizational, time management and follow-up skills.
• Knowledge of processing Electronic Data Interchange (EDI) file updates.
• Knowledge of Healthcare eligibility and billing procedures as well as HIPAA, Cobra and ERISA.
• Proficient with Microsoft Office Suite, Google Workspace and Adobe.
• Experience with CRM software preferably Salesforce.
• Ability to communicate effectively and interpret a variety of instructions in a fast-paced environment.
• Bachelor's and/or an associate degree plus 3 years administrative expertise or any combination education and experience that has been achieved and is equivalent to the stated education and required knowledge.