Enrollment and Eligibility Specialist

About The Role

Brighton Health Plan Solutions is seeking an experienced Specialist for our Enrollment and Eligibility/ Employer Services Department to work remotely. 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.
The Enrollment and Eligibility Specialist plays a critical role in our Enrollment and Eligibility/Employer Services Department. Our Specialists are responsible for completing the day-to-day functions of the enrollment and eligibility processing, ensuring that participants are appropriately enrolled in the correct health plan, supporting Eligibility Call Centers, as well as managing the daily communication requirements to and from participants. The E&E Specialists must be very detail orientated in order to ensure that all forms and documents received in house are processed efficiently, and according to procedure, as well as ensuring that all eligibility and enrollment functions are completed in a timely and accurate manner. The E&E Specialists are also responsible for supporting the client, employers, and members via phone and email support.

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 Clients, Employer Partners, Health Plan Carriers, the COBRA vendor, and Call Center Representatives.
• 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.
• Other duties as required .

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.
• 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 365 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 (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it. Based in New York City, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing tangible innovation to the health care delivery system. Our team is committed to transforming how health care is accessed and delivered. We believe that cost, quality, and population health are optimized when people have long term relationships with their health care providers – and that’s why we’re creating new products that today do not exist anywhere in the New York/New Jersey market. With a growing labor business under the well-known MagnaCare brand, the launch of Create - a new marketplace of health systems focused on self-insured commercial health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners.

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.

*We are an EEO Employer