Eligibility Specialist

Siho Insurance Group; Columbus (IN); Hybrid; USD 38,000 - 46,000; Full time

Job summary

Siho Insurance Group in Columbus, IN, seeks an Eligibility Specialist to handle enrollment and eligibility for SIHO customers in a non-exempt role. Responsibilities include responding to inquiries, enrolling or terminating eligibility, and maintaining audit reports.

The role requires expert Excel/Word skills, meticulous attention to detail, problem solving, strong communication, and a solid understanding of health insurance. Internal candidates need a PMAS 3+ rating.

Qualifications

• Expert level computer skills in Excel and Word.
• Detail oriented with high accuracy.
• Strong problem solving and analytical abilities.
• Organizational and time management skills.
• Excellent written and oral communication and customer service.
• General knowledge of health insurance.
• Ability to work in a changing, multi-task environment.
• Commitment to confidentiality under HIPAA.
• PMAS performance rating of 3 or higher for internal candidates.

Responsibilities

• Respond to inquiries from accounts concerning eligibility issues.
• Assist internal customers with eligibility concerns.
• Enroll, terminate, and change eligibility information as requested.
• Initiate student certification, tax dependent verification and disabled dependent verification.
• Maintain eligibility audit reports.
• Process enrollment of new groups as assigned.
• Handle terminations of groups as assigned.
• Track ID Card orders and re-orders.
• Track eligibility issues and interactions in the membership system.
• Prepare and communicate special reports as required by accounts.
• Develop and maintain statistical data as required.
• Create and mail letters of creditable coverage.

Skills

Excel

Word

Attention to detail

Problem solving

Analytical skills

Organization

Time management

Communication skills

Customer service

HIPAA knowledge

PMAS evaluation

Tools

Microsoft Excel

Microsoft Word

Job description

Job Title: Eligibility Specialist

Reports To: Manager of Eligibility

This is a non-exempt position with primary responsibility for handling enrollment and eligibility for SIHO customers. This data entry position is also responsible for assisting employer contacts with needs pertaining to eligibility and providing reports and other information as needed.

Brief Description of Duties:

• Respond to telephonic, written inquiries, and emails from accounts concerning eligibility issues.
• Assist internal customers concerning eligibility issues.
• Enroll, terminate, and change eligibility information as requested.
• Initiate and handle student certification, tax dependent verification and disabled dependent verification.
• Maintain eligibility audit reports.
• Process enrollment of new groups as assigned.
• Handle terminations of groups as assigned.
• Track ID Card orders and re-order as needed.
• Track eligibility issues and interactions in the membership system.
• Prepare and communicate special reports as required by accounts.
• Develop and maintain statistical data as required.
• Create and mail letters of creditable coverage.

Minimum Skills Requirement:

• Expert level computer skills (Microsoft Excel and Word)
• Detail oriented - high accuracy rate and attention to detail
• Demonstrated problem solving and analytical skills.
• Proven organization and time management skills.
• Excellent communications (oral and written) skills.
• Excellent customer service skills
• General knowledge and understanding of health insurance.
• Ability to work at a self-directed pace in a changing, multi-task environment.
• Professional appearance and presence
• Commitment to support and maintain confidentiality in accordance to HIPAA guidelines
• Current PMAS performance evaluation of "3" or higher (for internal candidates)

*All positions are subject to change based on the needs of the business