Eligibility Associate Representative

Immediate need for a talented Eligibility Associate Representative. This is a 03+ Months Contract opportunity with long-term potential and is located in U.S.(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-58274

Pay Range: $16 - $16.16/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• Facilitates accurate processing of Enrollment applications to ensure timely input and acceptance to CMS.
• Performs account benefit verification requiring complex decision skills based on payer and process knowledge resulting in proper access to care.
• Process Reconciliation files from CMS to include Disenrollments, Late Enrollment Penalties and Low Income Subsidies.
• Timely and Accurate processing of monthly Premium payments including identification and processing of write offs, resolution of credit balances and posting of payments to member accounts. 
• Process Coordination of Benefits and Medicare Secondary Payer files from CMS to meet Federal and State Regulatory guidelines.
• Ensure accuracy of data entry to allow for meeting proper Service Level Agreements.
• Use discretion & independent judgement in handling more complex cases and be willing to learn new skills within the Enrollment Functions.
• Directly interfaces with other teams.
• Provide support to other internal functions as needed.
• May need to be proficient in Multiple Systems.
• Completes other projects and additional duties as assigned.

Key Requirements and Technology Experience:

• Skills-Customer Service, Medicare Knowledge, Health insurance
• Analytical skills.
• Customer Service Skills.
• Quick Learner.
• Knowledge of CMS Enrollment & Reconciliation process.
• Knowledge of CMS Billing requirments and regulations.
• Knowledge in Coordination of Benefits and Medicare Secondary Payer.
• Medicare Part C and Part D.
• Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• Excellent presentation and communication skills.
• Demonstrated ability to handle challenging interactions in a professional manner.
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
• Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
• SQL (a plus not required)
• High school diploma or GED required, bachelor’s degree preferred.
• 3+ years of relevant working experience. 

Our client is a leading health insurance Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .

#prof J2W:CB3