Benefits & Eligibility Operations Specialist

LSMA Management, Inc.; San Bernardino (CA); On-site; USD 36,000 - 40,000; Full time

Job summary

LSMA Management, Inc. is seeking a Benefits & Eligibility Coordinator to support configuration and eligibility processing in a managed care environment.

You will help maintain member demographics, benefit structures, and eligibility records to ensure accurate claims adjudication and timely provider reimbursement. Under the Benefits & Eligibility Manager, you will process updates, handle queues, research discrepancies, and collaborate with Claims, IT, and Provider Services to resolve issues and

Qualifications

• Minimum: High school diploma or equivalent.
• Preferred: Associate’s degree or college coursework in Healthcare Administration, Business, or related field.
• Minimum: At least two (2) years of experience in Managed Care Eligibility, Benefits Administration, or healthcare administrative operations.
• Preferred: Experience in a managed care, MSO, IPA, or health plan environment; familiarity with member eligibility, eligibility files, benefits, and systems such as EZ-Cap.
• Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
• Intermediate computer and technical skills, including use of EZ-Cap or equivalent systems.

Responsibilities

• Process benefit and eligibility updates, manage queues, and research data discrepancies.
• Assist with routine eligibility file validation.
• Collaborate with Claims, IT, Provider Services, and other internal departments to resolve issues and maintain accurate member information.

Skills

Eligibility processes

Benefit configuration

Enrollment processes

Data quality

Data entry

HIPAA compliance

Attention to detail

Communication

SOP adherence

System independence

Education

High school diploma or equivalent

Associate’s degree or college coursework in Healthcare Administration, Business, or related field

Tools

EZ-Cap

Job description

LSMA Management, Inc. is seeking a Benefits & Eligibility Coordinator to support configuration and eligibility processing in a managed care environment.

You will help maintain member demographics, benefit structures, and eligibility records to ensure accurate claims adjudication and timely provider reimbursement. Under the Benefits & Eligibility Manager, you will process updates, handle queues, research discrepancies, and collaborate with Claims, IT, and Provider Services to resolve issues and