A Medical Health Insurance Plan based in Los Angeles is in the immediate need of a Eligibility Coordinator (customer service professional). This position interfaces with department management, department staff and other Plans' staff including the Audit, Contributions, Accounting, Benefits Analyst, Pension, Health Claims and Operations Departments. Phone contact with participants, participants' representatives and production companies.
Day-to-day responsibilities:
- Answer eligibility calls from participants and participants' representatives.
- Assist with open enrollment process.
- Adjust participant records: add/delete, reinstate, terminate, and promote dependents.
- Coordinate with providers to update participants' and dependents' coverage.
- Process and set up coverage for retirees, and divorced and surviving spouses.
- Set up COBRA and Self-pay coverage where applicable.
- Monitor Delta Dental, ESI and Anthem Discrepancy reports through vendor 834 files and resolve issues.
- Monitor and follow-up on Affidavit of Surviving Spouse, Dependent Confirmation Forms, disabled child verification, and Coordination of Benefits.
- Assist any “walk-in” participants with any eligibility matters. Address questions regarding coverage and receive payments if necessary.
- Compose correspondence in relation to eligibility issues and required documents such as second documentation for marriage, marriage, and death/birth certificates.
- Prepare and reconcile Delta Care invoices to vendor for payment on a monthly basis.
- Prepare and reconcile premiums for East Coast Assistant Directors Trainee premiums.
- Process refunds due to overpayment or loss of coverage.
- Prepare and reconcile with the Pension Dept. regarding retiree pension deduction list.
- Create tailored letters regarding eligibility information as needed.
- Review appeals due to late payment of premiums and late notice for adding dependents, and for change of coverage plan, COBRA qualifying events and election or notification expired for COBRA or during open enrollment.
- Perform Retiree Drug Subsidy (RDS) reconciliation and compliance.
- Handle reconciliation of Medicare Drug Subsidy program and CMS Section 111.
- Coordinate with Address Change Dept. regarding participants' missing addresses.
- Regular, predictable, and reliable attendance in office is required.
- Ability to accept direction and developmental guidance from supervisor.
- Prepare daily correspondence/document for scanning.
- Perform other duties as assigned.
Required skills and experience:
- Excellent verbal and written communication skills
- Strong analytical and math skills
- Excellent organizational skills and attention to detail
- Proficient in Microsoft Word, intermediate knowledge of Excel
- Ability to prioritize workload, meet deadlines and work independently with minimal supervision