Insurance Eligibility Coordinator

PURPOSE OF THE ROLE

The IT Operations Specialist is responsible for the maintenance and evaluation of member data files that affect commercial and managed care group enrollment, RDS enrollment, and member card production. The role involves assessing incoming data files and maintaining logs, tables, and databases related to member enrollment. The position is responsible for notifying the IT department and its members when issues need to be addressed and run routine applications on a day-to-day basis. This position will report directly to the IT Operations Manager.

KEY TASKS AND RESPONSIBILITIES

• Work with the IT Operations Manager to set objectives.
• Enhance and automate daily activities for better productivity.
• Ability to handle multiple projects, manage timelines and meet specific deadlines.
• Participate in Quality Management Program committee planning, and meetings as needed
• Support and assist with additional tasks, responsibilities and duties as deemed necessary by the

IT Operations Manager

• Specific responsibilities include, but are not limited to, the following areas:

• Electronic Eligibility
  1. Maintain all electronic user detail (add/term/modify/delete).
  2. Analyze incoming file layouts.
  3. Setup and test all new files.
  4. Maintain any special group/location mapping.
  5. Maintain any special member number setup.
  6. Manage member ID conversions.
  7. Work with Tech Support on any new programming developments.
• Medicare Part D (RDS)
  1. Maintain RDS application and group detail in the RDS database.
  2. Post enrollment files to CMS.
  3. Process enrollment response files received from CMS.
  4. Process cost reports as needed and quarterly.
  5. Request and process CMS covered retiree reports during plan year reconciliation.
  6. Maintain RDS website users, instructions provided to the users and instructions posted on the website.

QUALIFICATONS

• Bachelor’s Degree or equivalent experience preferred
• 3-5 years of experience in IT file administration and/or Insurance Eligibility management

PROFESSIONAL SKILLS, EXPERIENCES AND COMPETENCIES

• Proficiency with the Microsoft Office suite
• Able to support multiple tasks, initiatives, and projects simultaneously
• Excellent verbal and communication skills, across various levels of the organization
• Strong technical aptitude and interpersonal skills
• Excellent problem-solving skills and able to work under high pressure situations
• Strong organizational and project management skills