Eligibility Coordinator

Reports To

Assistant Manager, Eligibility

This position interfaces with department management, department staff and other Plans’ staff including the Audit, Contributions, Accounting, Benefits Analyst, Pension, Health Claims and Operations Departments. Phone contact with participants, participants’ representatives and production companies.

• Answer eligibility calls from participants and participants’ representatives.
• Assist with open enrollment process.
• Adjust participant records: add/delete, reinstate, terminate, and promote dependents.
• Coordinate with providers to update participants’ and dependents’ coverage.
• Process and set up coverage for retirees, and divorced and surviving spouses.
• Set up COBRA and Self-pay coverage where applicable.
• Monitor Delta Dental, ESI and Anthem Discrepancy reports through vendor 834 files and resolve issues.
• Monitor and follow-up on Affidavit of Surviving Spouse, Dependent Confirmation Forms, disabled child verification, and Coordination of Benefits.
• Assist any “walk-in” participants with any eligibility matters. Address questions regarding coverage and receive payments if necessary.
• Compose correspondence in relation to eligibility issues and required documents such as second documentation for marriage, marriage, and death/birth certificates.
• Prepare and reconcile Delta Care invoices to vendor for payment on a monthly basis.
• Prepare and reconcile premiums for East Coast Assistant Directors Trainee premiums.
• Process refunds due to over payment or loss of coverage.

• Excellent verbal and written communication skills
• Strong analytical skills
• Good math skills

• Bachelor’s Degree with 2-3 years of customer service experience in group health insurance preferred.

Possess manual dexterity sufficient to operate standard office machines. Ability to sit or stand for extended periods of time. Position requires bending, reaching, walking, and lifting of up to 10 lbs.

Non-Exempt

• Onsite

• $22.12/Hour