Eligibility Processor (Troy, MI)
BeneSys, Troy, MI, United States
Eligibility Processor
The Eligibility Processor will review and process eligibility inquiries as well as determine, maintain, and terminate member and/or dependent eligibility for healthcare benefits. Processors provide support to the healthcare service team, supervisors, and manager, when necessary.
Essential Duties and Responsibilities Include But Are Not Limited To:
Understand the plan rules for eligibility as outlined in the Summary Plan Description (SPD)
Process month end reporting
Use reports to determine eligibility, reinstatement, or termination of coverage
Prepare & mail enrollment packages and ID cards for newly eligible members
Review calc reports and exception reports to update eligibility, as needed
QA self-payment notices, COBRA notices, status slips, member/dependent letters to ensure accurate information and timely mailing to participants
Processing eligibility documents in OnBase for clients
New member forms
Vital information forms
Medicare information forms
Other insurance information forms
Member/dependent PHI
ACH authorization
Death notifications
Qualified Medical Child Support Order (QMSCO)
Eligibility appeals
Loss of time credits
Enrollment escalation requests (call center resolution form)
Vendor file approvals
Vendor discrepancy reports
Evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules
Process payments for health & welfare coverage
Request missing information from members
Process eligibility escalations within 24 hours and call back members with updates, as needed
Work with the pension department to ensure H&W deduction amounts are correct and properly set up for retired members and surviving spouses
Responsible for class code and coverage changes when member's status changes, such as adding/terming dependents, disability, retirement, or death
Understand Medicare rules and regulations to determine eligibility for Medicare benefits and update coordination of benefits in appropriate systems
Verify and maintain employee demographic information, such as member or dependent address, contact numbers, birth date, social security number, or MBI number
Comment system with appropriate updates based on documentation received
Review and approve any plan changes, such as H&W rate changes, eligibility rule changes, or benefit changes with a vendor
Meet daily/weekly quota requirements set by management team
Update Redbook when necessary; within 24-48 hours of change notification
Be knowledgeable of policies, procedures, and coverage of various funds
Regular and predictable attendance is an essential function of this job
Qualifications
Excellent multi-tasking skills are a must. Preferred Qualification - Spanish speaking. Education and/or Experience High school diploma or GED and one year of eligibility experience preferred. Language Skills Must speak clearly and professionally. Ability to understand directions and follow them to completion of requested task. Mathematical Skills General math skills. Reasoning Ability - Ability to apply common sense to carry out detailed written or verbal instructions. Work Environment - Fast-paced department. Must be able to work independently as well as in a team, must be able to multi-task and detailed oriented. Work Schedule - Full time. Monday - Friday, 7:30am - 4:30pm. Required in office (no at-home days).
Competitive Benefits and Compensation Package
12 paid holidays
Paid Time Off (PTO)
Pro-rated during first year of employment
15 days of PTO provided in the next calendar year!
3 days paid bereavement
Up to 20 days paid jury leave
Medical, dental, and vision insurance, with option for dependent coverage
Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
401k with employer match
Tuition reimbursement program
Career development opportunities
Referral bonus for all successful full-time referrals
Annual opportunities for increases
Pay - The pay for this position is $23.00 per hour. Actual salary is dependent on skills, experience, education, and other business factors.
Our Culture
BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential. Our culture focuses on three core values:
Collaboration: working together across 31 locations to achieve the best for the company and our clients
Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
The Eligibility Processor will review and process eligibility inquiries as well as determine, maintain, and terminate member and/or dependent eligibility for healthcare benefits. Processors provide support to the healthcare service team, supervisors, and manager, when necessary.
Essential Duties and Responsibilities Include But Are Not Limited To:
Understand the plan rules for eligibility as outlined in the Summary Plan Description (SPD)
Process month end reporting
Use reports to determine eligibility, reinstatement, or termination of coverage
Prepare & mail enrollment packages and ID cards for newly eligible members
Review calc reports and exception reports to update eligibility, as needed
QA self-payment notices, COBRA notices, status slips, member/dependent letters to ensure accurate information and timely mailing to participants
Processing eligibility documents in OnBase for clients
New member forms
Vital information forms
Medicare information forms
Other insurance information forms
Member/dependent PHI
ACH authorization
Death notifications
Qualified Medical Child Support Order (QMSCO)
Eligibility appeals
Loss of time credits
Enrollment escalation requests (call center resolution form)
Vendor file approvals
Vendor discrepancy reports
Evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules
Process payments for health & welfare coverage
Request missing information from members
Process eligibility escalations within 24 hours and call back members with updates, as needed
Work with the pension department to ensure H&W deduction amounts are correct and properly set up for retired members and surviving spouses
Responsible for class code and coverage changes when member's status changes, such as adding/terming dependents, disability, retirement, or death
Understand Medicare rules and regulations to determine eligibility for Medicare benefits and update coordination of benefits in appropriate systems
Verify and maintain employee demographic information, such as member or dependent address, contact numbers, birth date, social security number, or MBI number
Comment system with appropriate updates based on documentation received
Review and approve any plan changes, such as H&W rate changes, eligibility rule changes, or benefit changes with a vendor
Meet daily/weekly quota requirements set by management team
Update Redbook when necessary; within 24-48 hours of change notification
Be knowledgeable of policies, procedures, and coverage of various funds
Regular and predictable attendance is an essential function of this job
Qualifications
Excellent multi-tasking skills are a must. Preferred Qualification - Spanish speaking. Education and/or Experience High school diploma or GED and one year of eligibility experience preferred. Language Skills Must speak clearly and professionally. Ability to understand directions and follow them to completion of requested task. Mathematical Skills General math skills. Reasoning Ability - Ability to apply common sense to carry out detailed written or verbal instructions. Work Environment - Fast-paced department. Must be able to work independently as well as in a team, must be able to multi-task and detailed oriented. Work Schedule - Full time. Monday - Friday, 7:30am - 4:30pm. Required in office (no at-home days).
Competitive Benefits and Compensation Package
12 paid holidays
Paid Time Off (PTO)
Pro-rated during first year of employment
15 days of PTO provided in the next calendar year!
3 days paid bereavement
Up to 20 days paid jury leave
Medical, dental, and vision insurance, with option for dependent coverage
Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
401k with employer match
Tuition reimbursement program
Career development opportunities
Referral bonus for all successful full-time referrals
Annual opportunities for increases
Pay - The pay for this position is $23.00 per hour. Actual salary is dependent on skills, experience, education, and other business factors.
Our Culture
BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential. Our culture focuses on three core values:
Collaboration: working together across 31 locations to achieve the best for the company and our clients
Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.