Job Title: Client Services & Eligibility Specialist
Job Overview
We are looking for a Client Services & Eligibility Specialist to manage and ensure the accuracy of employee eligibility data for health benefits. In this role, you will work with brokers, employers, and third-party administrators (TPAs) to validate and process eligibility information, ensuring seamless access to services. This is a remote position with a focus on operational excellence and precision in handling sensitive data.
Key Responsibilities
Eligibility Management (Primary Focus)
* Manage day-to-day eligibility operations for brokers, employers, and TPAs.
* Process member adds, terms, and updates via spreadsheets, file transmissions, and system entries.
* Review and validate eligibility files for accuracy, completeness, and formatting requirements.
* Monitor file transmissions, investigate anomalies, and resolve data errors.
* Research and correct eligibility discrepancies, coordinating with clients and partners.
* Ensure all eligibility changes are processed accurately and in a timely manner to support seamless member activation and benefit access.
Client Communication & Support
* Serve as a primary point of contact for client eligibility questions-via email, chat, phone, and video.
* Provide clear guidance to clients on eligibility processes, file formats, timelines, and requirements.
* Document trends, recurring issues, and potential solutions to improve the client experience.
Onboarding & Data Coordination
* Assist with onboarding new clients by collecting and managing eligibility-related data.
* Confirm required file specifications, eligibility layouts, and transmission processes.
* Collaborate with internal teams to ensure onboarding data is accurate and ready for launch.
Continuous Improvement & Collaboration
* Identify process barriers or gaps in eligibility workflows, recommending enhancements.
* Work cross-functionally to align service delivery, file processing, and technical operations with client needs.
* Maintain a strong working knowledge of products, benefits, and systems to support accurate eligibility handling.
Qualifications
* Proven experience in eligibility management, client services, customer success, benefits administration, or a related operational role.
* Strong attention to detail with the ability to identify and resolve data inconsistencies.
* Excellent written and verbal communication skills, including the ability to explain technical and data-related information clearly.
* Proficiency with spreadsheets, eligibility file formats, remote communication tools (Zoom, Slack), CRM platforms, and digital support systems.
* Strong organizational and time management skills, with the ability to manage multiple clients and file timelines.
* Problem-solving mindset with a focus on delivering accurate, timely solutions.
* Ability to work independently while collaborating effectively with a small, agile team.
* Adaptable, flexible, and comfortable stepping into various responsibilities within a dynamic environment.
What We Offer
* Competitive Salary
* Opportunities for Career Development
* Collaborative Team Culture
* Employee Benefits