Welcome to a team of caring and passionate people who work each day to meet the needs of our members and clients. At Health Benefits, you will be part of an organization committed to offering custom services to self-funded health benefits plans that manage costs – without compromising benefits – by offering innovative solutions, flexibility, transparency and customer support. We are now a subsidiary of Health Care Service Corporation, the largest customer-owned insurance company in the United States and a strategic partner of Health Benefits since 2018, giving us access to increased national scale and support. This is an exciting time to join our team and enhance our culture that emphasizes caring, diversity and inclusion, mutual respect, collaboration and service to our communities.

This position includes a variety of technical tasks that support the Eligibility Department. The responsibilities of a Technical Eligibility Analyst may vary depending upon the needs of the Department and may include loading Triple E files and manual eligibility updates.

In addition to these tasks, the Technical Eligibility Analyst is responsible for all of the same tasks as an Eligibility Analyst, including providing quality service by timely and accurately entering and/or modifying eligibility data in Health Benefits systems according to established procedure and client requirements. This position is also responsible for responding to telephone, written and electronic inquiries from employees/members, clients and co-workers.

Responsibilities Include:

• Resolve client or employee/member issues regarding eligibility.
• Work with Business Analysts to resolve electronic eligibility and real time Eligibility issues.
• In partnership with Business Analyst, test Triple E and other electronic eligibility submissions.
• Participate in Eligibility testing for new clients and renewal changes.
• Write and/or request eligibility reports (WCW and RFCs).
• Participate in eligibility projects and/or error resolution.
• Loading Triple E files and Error reporting / Discrepancy Report to client / Vendor.
• Working Triple E file reports.
• Proactively provide appropriate communication with internal team members, vendors, and clients.
• Effectively use reference materials such as Reference Sheets and BRS procedures.
• Based upon the client’s requirements and methods of eligibility submission, review, interpret, enter, process and/or audit enrollments, terminations and eligibility change requests in a timely and accurate manner utilizing any Health Benefits system, e.g. PowerSTEPP, Real Time Eligibility/portal, Triple E reports.
• Review and resolve eligibility error and audit reports.
• Maintain assigned eligibility Work Queues according to Health Benefits procedure and turnaround time expectations.
• Work with Team Leader and/or Technical Eligibility Analyst to resolve electronic eligibility and Real Time Eligibility issues.
• Request ID Cards and distribute as required.
• Process requests for proof of coverage
• Audit Dependent Eligibility, when required
• Respond to telephonic, written and electronic inquiries from clients/brokers, employees/members, and co-workers regarding eligibility, DEA and ID Card related issues.
• Treat all inquiries professionally and respectfully following Health Benefits guidelines
• Appropriately refer or escalate calls based on customer service procedures and guidelines.
• Research inquiries and respond appropriately.
• Follow-up regularly on outstanding issues to ensure timely resolution and client satisfaction.
• Thoroughly and accurately document all inquiries using PowerSTEPP and Family Files following Health Benefits guidelines.

Requirements include:

• A minimum of 3 years of eligibility experience is strongly preferred.
• Ability to work in a fast-paced, customer service and production driven environment
• Exceptional data entry skills with high attention to detail.
• Prior experience working with EDI files and the ability to process/load into systems preferred.
• Excellent verbal and written communication skills
• Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Management staff all levels of staff
• Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
• Flexible; open to continued process improvement
• Self-directed individual who works well with minimal supervision
• Good leadership, organizational and interpersonal skills
• Demonstrated critical thinking skills
• Ability to effectively deal with problems in varying situations and reach resolution
• Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word.

At Health Benefits, you will be part of an organization committed to offering meaningful benefits to our associates to support their life outside of work. From health and wellness benefits, 401(k) savings plan, a minimum of 15 days of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, new parent paid leave, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time associates.

The compensation range for this full-time Senior Claims Analyst position is between $17.28/hr. and $32.44/hr. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran or disability.