Eligibility Representative

Immediate need for a talented Eligibility Representative. This is a 04+ months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-22422

Pay Range: $19/hr - $19.35/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Process and maintain eligibility and enrollment transactions, including updates, corrections, and reconciliations of member data
• Review and analyze eligibility reports to identify discrepancies and ensure accurate resolution
• Implement and maintain data across automated systems, direct connections, and manual workflows
• Verify eligibility and ensure compliance with Medicare guidelines and regulatory requirements
• Partner with internal teams (e.g., systems, operations) to investigate and resolve data or processing errors
• Perform detailed data entry and validation tasks with a high level of accuracy and timeliness
• Monitor transaction outputs to ensure completeness and adherence to established standards
• Important Role Clarification
• This role is not primarily customer service-based and does not focus on call handling. This role is customer focus , not customer service . We don t speak to members at all really.
• Responsibilities center on processing enrollment transactions and eligibility data, which require strong analytical skills and attention to detail
• Verifying eligibility and processing enrollment applications/transactions are distinct functions, with this role emphasizing transaction processing and data integrity

Key Requirements and Technology Experience:

• Working knowledge of Medicare Advantage enrollment and eligibility (Part A, Part B, and Part C)
• Strong analytical and problem-solving skills with a data-focused mindset
• High attention to detail and ability to manage large volumes of transactional work
• Proficiency in Microsoft Office Suite (especially Excel)
• Ability to work independently with minimal supervision
• Strong written communication skills for internal collaboration
• 1+ year of experience in healthcare insurance
• 1+ year of experience in enrollment and eligibility processing (Medicare Advantage preferred)
• Prior experience with data entry, enrollment systems, and transaction processing

Our client is a leading Health insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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