About the Role Brighton Health Plan Solutions (BHPS) is seeking an experienced Specialist for our Enrollment and Eligibility/ Employer Services Department, as a REMOTE role. We are a hybrid unit, a balance of a contact center and processing department.  The Enrollment and Eligibility Team’s (EET) mission is to create, audit, process and update the member and eligible dependents’ profile(s) keeping their health, well-being, and continuity of care at the forefront of our day-to-day operations. And we partner and collaborate with key stakeholders (the client, employer partners, Customer Service, IT, Finance, Carriers, Vendors, and more) to do so successfully and timely.   Ideally, the interested candidate is experienced in various eligibility requirements including, data entry, hourly based determinations, premium billing and reconciliation and also has strong interpersonal skills (preferably some Call/Contact Center) experience to resolve member eligibility queries. Specialists will interact with fund administrators, employers, members, call center representatives, Finance and IT team members to conduct investigations, audits and reconciliations as needed. MagnaCare shall serve as the client’s Third-Party Administrator for our West Coast Client and interact with the aforementioned throughout the workday via phone or email from 8am to 6pm PST (11am to 9pm EST). This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities and activities may change, or new ones may be assigned at any time with or without notice. Primary Responsibilities + Case Management: Create, audit, process and update the member and eligible dependents’ profile(s) into the enrollment database & update the database with changes. + Data Analytics: Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes. + Troubleshoot Enrollment and Eligibility related inquiries from the Call Center Representatives and Employers. + Works directly with the Finance team to review, process, and resolve inquiries from the employers and premium related issues: including outreach to employers, the client and State officials --as needed. + Contact Employers regarding delinquencies and late file submissions –when applicable.   + Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of   requests from the client, employers, and members. + Participate in activities designed to improve customer satisfaction and business performance. + Solve problems that are sometimes out of the ordinary and that may require reliance on conceptual thinking. Maintain broad knowledge of client requirements, procedures and key contacts. + Support projects and other departments in completing tasks/projects. Essential Qualifications + Ability to work alternate schedules/hours based on the business’s need. Our client is on the West Coast.  As such, the department’s hours are 10am-9pmEST (7am-6pm PST). + Bachelor’s Degree preferred or High School diploma / GED (or higher) OR 5-7 years of equivalent working experience. + 2+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties. + Knowledge of managed care, labor and commercial carrier enrollment and eligibility procedures including hourly based eligibility and waiting periods. + Knowledge of eligibility files and transaction sets a plus. + Must be able to process and/or enter sensitive PHI and confidential Financial Information.  + General knowledge of HIPAA Confidentiality laws. + Proficiency in HIPAA, COBRA, FMLA, LOAs, QLE, PTO regulations and other eligibility related transactions preferred. + Knowledge of Medicare/Medicaid Benefits is a plus. + Knowledge of Salesforce is a plus. + Moderate proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications. + Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product. + Ability to use critical thinking to solve complex problems and identify when to escalate. + Excellent attention to detail, analytical, and good problem solver. + Excellent attendance, punctuality and work performance record required. + Must maintain a high-level of professionalism and communication skills (written and verbal) at all times. + Excellent interpersonal and organizational skills. + Must be susceptible to change and change management. + Must be a team player that is able to work independently as well. About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™. Company Mission Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners. Company Vision Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways. DEI Purpose Statement   At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities.   We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.  We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level. *We are an Equal Opportunity Employer JOB ALERT FRAUD:  We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information.  Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section.  If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: recruiting@brightonhps.com Powered by JazzHR