Commercial Eligibility & Enrollment Analyst

MCS Health; San Juan (PR); Sur place; USD 38 000 - 52 000; Plein temps

Résumé du poste

MCS Health is seeking a healthcare eligibility analyst to analyze and process member eligibility transactions, validate data in the system, and resolve discrepancies affecting billing and benefits access. You will review policyholder coverage, tiers, and COBRA/LTD/Retired divisions, ensuring accurate setup within the eligibility system and responding to inquiries from the Call Center and Billing units.

Qualifications include a degree in healthcare administration or related fields, with at least

Qualifications

• Bachelor's Degree in Healthcare Administration, Business Administration, or related areas.
• At least six (6) months of experience in processes related to group and individual enrollment and data entry experience, preferably in the Health Insurance Industry.
• Associate's Degree or sixty to sixty-four (60-64) approved college credits with at least six (6) months of enrollment/data entry experience.

Responsabilités

• Audits and analyzes eligibility discrepancies to validate data in MHS.
• Analyzes VIP policyholder eligibility history to determine system setup.
• Reviews coverage, family composition, benefits packages, and divisions to ensure complete and error-free information.
• Corrects errors in reporting coverage, billing, and policyholder setup to enable proper billing.

Description du poste

MCS Health is seeking a healthcare eligibility analyst to analyze and process member eligibility transactions, validate data in the system, and resolve discrepancies affecting billing and benefits access. You will review policyholder coverage, tiers, and COBRA/LTD/Retired divisions, ensuring accurate setup within the eligibility system and responding to inquiries from the Call Center and Billing units.

Qualifications include a degree in healthcare administration or related fields, with at least