Eligibility Specialist
Eligibility Specialist
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Job Description
Title: Eligibility Specialist Department: Associated Administrators
FLSA: Non-exempt Hours per week: 40
Position Summary
The Eligibility Specialist provides customer service to participants beneficiaries union locals and providers regarding eligibility benefits and claims status.
Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role.
Key Duties and Responsibilities
- Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.
- Provides written verbal or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.
- Updates files including documenting system notes of conversations or action taken.
- Performs tasks associated with the administration of retirement and health and welfare benefits such as;
- Processing and/or sending mailers or required forms as requested by members.
- Processing and/or sending correspondence related to member or claims status.
- Processing enrollments and updating member information in applicable system(s).
- Distributing communications related to regulatory requirements.
- Initiates Action Requests to appropriate departments requesting adjustments to claims retirement and/or eligibility as necessary. Follows up to ensure successful completion of Action Request.
- Researches and resolves complex and technical issues and irregularities.
- Performs other duties as assigned.
Minimum Qualifications
- High school diploma or GED.
- Six months of experience working in customer service third-party administrator processing or benefits administration.
- Strong work ethic and team player mentality.
- Highly developed sense of integrity and commitment to customer satisfaction.
- Ability to communicate clearly and professionally both verbally and in writing.
- Solid organization skills with strong detail orientation and listening skills.
- Ability to read analyze and interpret general business materials technical procedures benefit plans and regulations.
- Proficient computer skills including MS Office tools and applications.
Preferred Qualifications
Call center experience in benefits claims billing or eligibility.
*Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee of this job. Duties responsibilities and activities may change at any time with or without notice.
Disability Accommodation
Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment including the application process. If reasonable accommodation is needed please contact the Recruiting Department at and we would be happy to assist you.
Zenith American Solutions
Real People. Real Solutions. National Reach. Local Expertise.
We are currently looking for a dedicated energetic employee with the necessary skills initiative and personality along with the desire to get the most out of their working life to help us be our best every day.
Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources best practices and scale the new organization is even stronger and better than before.
We believe the best way to realize our better systems for better service philosophy is to hire the best employees. Were always looking for talented individuals who share our dedication to high-quality work exceptional service and mutual respect. If youre interested in working in an environment where people - employees and clients - really matter consider bringing your talents to Zenith American!
We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package we offer an array of benefits including health vision and dental coverage a retirement savings 401(k) plan with company match paid time off (PTO) great opportunities for growth and much much more!
Required Experience:
Unclear Seniority
Employment Type
Full-Time
