Eligibility & Enrollment Processor

Zenith American Solutions; Wallingford (CT); 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 accurate member records and assisting with enrollment-related inquiries and documentation. This role ensures enrollment information is processed accurately, provides timely support to members and stakeholders, and coordinates with internal teams and external partners.

The position involves handling PHI/PII with appropriate security, performing duties in a typical office

Qualifications

• High School diploma or equivalent.
• Minimum 6 months general office experience demonstrating dependability.
• Strong work ethic and team player mentality.
• Commitment to integrity and customer satisfaction.
• Clear written and verbal communication skills.
• Excellent organizational skills with attention to detail.
• Ability to read, analyze, interpret business materials and regulations.
• Proficient with MS Office tools.

Responsibilities

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

Skills

Communication skills

Attention to detail

Team player

Integrity

Customer service

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.