Health Plan Eligibility & Risk Analyst - Onsite Valencia

Shield HealthCare; Washington (IL); On-site; USD 26,174 - 27,552; Full time

Benefits offered by this job

Medical, Dental, and Vision

401(k) with Company Match

Sick and Vacation Days

Flexible Spending Account

Life & Disability Insurance

Education Assistance

Employee Referral Program

Job summary

Shield HealthCare is seeking an Eligibility and Risk Specialist in Valencia, CA, responsible for verifying eligibility and managing health plan member records. This role involves researching claim issues, ensuring compliance with billing requirements, and maintaining positive relationships with third-party payers.

The ideal candidate will have strong communication skills, attention to detail, and proficiency in Microsoft Office. This is a full-time, on-site position offering competitive pay and benefits, including medical, dental, retirement plans, and education assistance.

Qualifications

• Familiarity with various medical insurance payer guidelines and billing requirements preferred.
• Proficiency in Microsoft Office, with experience in Microsoft Excel.
• Must be detail-oriented, thorough, accurate, and organized.

Responsibilities

• Responsible for verifying eligibility and risk delegation for health plan members.
• Ensure that all eligibility verification requests are completed timely.
• Research problems related to eligibility claim rejections and denials.
• Maintain accurate records of customer accounts.

Skills

Familiarity with medical insurance payer guidelines

Proficiency in Microsoft Office

Detail oriented and organized

Research and problem-solving skills

Good communication skills

Job description

Shield HealthCare is seeking an Eligibility and Risk Specialist in Valencia, CA, responsible for verifying eligibility and managing health plan member records. This role involves researching claim issues, ensuring compliance with billing requirements, and maintaining positive relationships with third-party payers.

The ideal candidate will have strong communication skills, attention to detail, and proficiency in Microsoft Office. This is a full-time, on-site position offering competitive pay and benefits, including medical, dental, retirement plans, and education assistance.