Eligibility & Enrollment Processor

Zenith-American; Pittsburgh (Allegheny County); On-site; USD 36,000 - 48,000; Full time

Job summary

Zenith American Solutions is seeking an Eligibility & Enrollment Processor to support enrollment operations by maintaining member records and assisting with related processes. You will ensure accurate enrollment information and provide timely documentation to members and stakeholders.

The role includes handling inquiries, coordinating with internal teams and external vendors, and maintaining files in the administration system.

Qualifications

• High School diploma or equivalent.
• 6 months or more of general office experience demonstrating dependability.
• Clear verbal and written communication; professional interaction with members and stakeholders.
• Strong integrity and commitment to customer satisfaction.
• Proficient computer skills including MS Office tools.

Responsibilities

• Maintain current knowledge of Plan(s) and apply it in job functions.
• Respond to inquiries with written, verbal, or face-to-face service and document conversations.
• Maintain member and dependent files in the administration system.
• Resolve eligibility and enrollment issues with vendors.
• Handle inbound/outbound correspondence (ID cards, eligibility packets).
• Research and resolve complex issues and irregularities.
• Respond to inquiries from examiners and billing processors.
• Perform other duties as assigned.

Skills

Communication

Customer service

Teamwork

Detail orientation

Professional writing

Education

High School diploma or equivalent

Tools

MS Office

Job description

Position Summary

The Eligibility & Enrollment Processor supports enrollment operations by maintaining accurate member records and assisting with enrollment-related processes and inquiries. This role helps ensure enrollment information is processed accurately and that members and stakeholders receive timely support and documentation related to coverage and benefits. The position contributes to the efficient administration of enrollment activities and supports coordination with internal teams and external partners.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities

• Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.
• Provides written, verbal, or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.
• Maintain member and dependent files in the administration system.
• Resolve eligibility & enrollment issues with the various vendors (PPO'S.PBMs, etc.)
• Handle inbound and outbound correspondence, such as ID cards, eligibility packets, etc.
• Researches and resolves complex and technical issues and irregularities.
• Respond to inquiries from the examiners and billing processors concerning enrollment issues.
• Perform other job related duties as assigned.

Working Conditions/Physical Effort

Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements. May be subject to interruptions. May be required to lift a maximum of 25 lbs. Must be able to have flexible work schedule when workflow requires. Must meet established attendance and punctuality guidelines.

Minimum Qualifications

• High School diploma or equivalent.
• Minimum 6 months general office experience in which candidate has demonstrated dependability.
• Strong work ethic and team player mentality.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Solid organization skills with strong detail orientation and listening skills.
• Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.
• Proficient computer skills including MS Office tools and applications.

*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at [e-mail], and we would be happy to assist you.

Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American!

We realize the importance a comprehensive benefits program to our employees and their families.

As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

• health
• vision
• dental coverage
• retirement savings 401(k) plan with company match
• paid time off (PTO)
• great opportunities for growth
• much, much more

At Zenith American Solutions, we take immense pride in fostering a positive, respectful, and supportive work environment that provides challenging opportunities while supporting a healthy work/ life balance.

Our organizational culture is founded on principles of integrity, honesty and respect for all stakeholders, including our employees, clients, and business partners.

With a low employee turnover rate and a high rate of internal promotions and transfers, the Zenith team is proud to be a part of an 80-year legacy of excellence.

Our employees embody a spirit of integrity, take immense pride in their work, and are enthusiastic about referring others to join our team.