Eligibility Representative/Customer Service Rep


Nashville, Tennessee

22 days ago


Similar Jobs
Eligibility Representative/Customer Service Rep
Nashville, Tennessee

22 days ago

Job Description

Job Title: Eligibility Representative
Duration: 7 Months
Location: Remote
Ongoing Schedule: 6 AM-2:30 PM CST (Potential for OT)
Training Schedule: 8AMCST-5PMCST
Special Instructions:
  • This position is remote, and candidates can be sourced from across the US as long as candidates are available to support the necessary CST or EST schedules.
  • Candidates must have a quiet, private working environment with a high-speed, reliable internet connection.
  • Delivers basic technical, administrative, or operative Eligibility tasks. Implements and maintains eligibility for benefits. Implements, updates, and maintains automated, direct connect and/or manual eligibility data by keying information into the system. Interacts with internal partners and/or external clients/vendors. Analyzes data and reconciles eligibility for accuracy. Researches and resolves problems. Escalates difficult issues. Strong data entry and customer service skills. General product knowledge. Understands simple instructions and procedures. Performs Eligibility duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles.
  • Responsible for determining plan eligibility and enrolling members within CMS regulatory guidance.
  • Work to save members with incorrect/incomplete applications by performing customer, physician and/or agent outreach and using support tools. Maintain member demographic update and membership revalidation and apply eligibility requirements for membership changes.
  • Research and respond to eligibility inquiries as needed.
  • Ensures all enrollment eligibility is reconciled and maintained in accordance with CMS and departmental guidelines, requirements, regulations, policies, and procedures.
  • This position involves reviewing incoming applications, keying information into systems, determining eligibility, and saving submissions as needed.
  • Phone calls to potential customers and Medicaid systems will be made as needed throughout the day. In addition to phone calls, Medicaid websites will be reviewed to gather additional information and eligibility verification on enrollees.
  • 1-2 years of data entry and enrollment/eligibility experience highly preferred
  • 1-2 years of healthcare experience required
  • Experience with Medicare and state Medicaid is highly preferred
  • Candidates with enrollment or eligibility experience will take priority
  • Proficient with Microsoft Office suite products
  • Advanced PC Skills required
  • Strong attention to detail
  • Critical thinking
  • Ability to work with minimal supervision
  • Excellent verbal and written communication skills
  • Strong Customer Service skills
Top Non-Negotiable Skills
  • Autonomous/Self-motivated Worker
  • Analytical Thinker
  • Available/willing to work OT as it will be mandatory during the busy season
Education: HS Diploma required

CPRA:Notice to California Applicants: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com. 

About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation. 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $18.00/hr.