Commercial Eligibility & Enrollment Specialist

MCS Puerto Rico; San Juan (PR); On-site; USD 42,000 - 54,000; Full time

Job summary

MCS Puerto Rico seeks an Eligibility Analyst to analyze and process member eligibility transactions within the Commercial Eligibility unit. You will validate and update member data to ensure accurate coverage and billing information.

The role requires at least six months of enrollment and data entry experience in the health insurance sector, with bilingual Spanish and English capabilities. The position is on-site in San Juan, Puerto Rico.

Qualifications

• Bachelor’s Degree in Healthcare Administration, Business Administration, or related areas.
• At least six (6) months of experience in enrollment and data entry in health insurance.
• Proven experience may be replaced by previously established requirements.

Responsibilities

• Audits and analyzes eligibility discrepancies to validate data.
• Assesses policyholder eligibility history to ensure correct setup.
• Validates coverage, benefits packages, and COBRA/LTD classifications.
• Resolves billing and eligibility errors to enable correct claims processing.
• Handles eligibility maintenance like cancellations, activations, and changes.

Skills

Enrollment processing

Data entry

Audit & analysis

Spanish language

English language

Education

Bachelor’s degree in Healthcare Administration

Associate's degree or 60–64 approved college credits

Job description

MCS Puerto Rico seeks an Eligibility Analyst to analyze and process member eligibility transactions within the Commercial Eligibility unit. You will validate and update member data to ensure accurate coverage and billing information.

The role requires at least six months of enrollment and data entry experience in the health insurance sector, with bilingual Spanish and English capabilities. The position is on-site in San Juan, Puerto Rico.