Eligibility Optimization Analyst - Intake & Claims Insight

Pivotal Health; United States; Remote; USD 40,000 - 65,000; Full time

Job summary

Pivotal Health is seeking a detail-oriented intake specialist to support payor eligibility inquiries. You will be the first point of contact for eligibility questions, handle customer service tickets and calls, and pull claims data to identify root causes of issues.

You will also conduct ineligible claims reviews, decide which flags need correction, and communicate outcomes to stakeholders, while documenting recurring patterns and building materials to prevent future problems.

Responsibilities

• You'll be the first intake for payor eligibility inquiries, handle CS tickets and calls, and pull claims data to root-cause issues.
• You'll run the ineligible claims review, determine which flags are truly ineligible or product defaults to correct, and communicate outcomes.
• You'll fix problems at the source by documenting recurring patterns, building CS-facing materials, and owning eligibility-risk dashboards.

Job description

Pivotal Health is seeking a detail-oriented intake specialist to support payor eligibility inquiries. You will be the first point of contact for eligibility questions, handle customer service tickets and calls, and pull claims data to identify root causes of issues.

You will also conduct ineligible claims reviews, decide which flags need correction, and communicate outcomes to stakeholders, while documenting recurring patterns and building materials to prevent future problems.