With minimal supervision, creates new accounts or modifications to existing accounts. Works membership related issues. Monitors receipt of expected membership files and runs load jobs. Establishes and maintains effective and collaborative relationships with clients and vendor. Monitors and ensures performance standards and guarantees are met.
Participates with implementation teams to set up eligibility for new accounts.
Leads the Eligibility work effort with the client and the vendor through development to production.
Coordinates with IT and vendor to define file layout and mapping requirements.
Coordinates configuration changes or addition of business lines to existing accounts.
Monitors receipt of expected membership files, notify client and account management of delayed files.
Builds and fosters client relationship.
Runs membership load jobs. Researches issues for root cause.
Leads the effort with client and/or vendor to resolve all issues.
Responsible for initial Setup and ongoing maintenance of Eligibility setup / configuration.
Provides reporting to Management on a monthly and quarterly basis activity against documented standards and performance guarantees.
Identifies client data trends and acts as consultant to client to improve quality of data and the member experience.
Other Job Requirements
Responsibilities
Minimum of 2 years of customer service, claims, or general office experience.
Proficient with MS Office software.
Ability to type 60 WPM.
Strong ten key user.
Results and solution oriented; not afraid to ask questions
Proficient in Microsoft Office Suite, with primary focus being MS Excel and MS Access.
General Job Information
Title
Eligibility Processor II
Grade
17
Work Experience - Required
Claims, Customer Service
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
