Compensation Overview

Centivo is looking for Enrollment & Eligibility Coordinators to join our team! 

As an Enrollment & Eligibility Coordinator, you will handle the day-to-day administering of files, data, updates, and transmissions relating to medical plan enrollment and member eligibility. Additionally, you will determine the necessary qualifications for enrollment into the group’s medical plans, including verifying coverage rules, coordination of benefits, and handling medical ID card validations.

Responsibilities Include:

Working under the guidance of the Enrollment Lead, you will:

• Review system for eligibility, reinstatement, and termination of health care coverage
• Perform weekly audits for assigned clients using member census data to ensure coverage is accurate and monitor for file feed issues
• Identify the root cause of enrollment data discrepancies and address with the appropriate contacts to resolve
• Performs client census reviews for audit and billing purposes
• Complete manual enrollment of members into our system when necessary, including obtaining and entering demographic information and providing new member IDs
• Manage & validate ID card releases for all groups
• Support the loading, transfer, and archive of the daily ID card print files from our claims record system to our print vendor. Ensure holds are in place and cards are released for printing by daily schedules, as well as by coordination with other members of the configuration team.
• Monitor and respond to Eligibility messages and requests received from Member Care/CSM and directly from client contacts through email, CRM, and JIRA queues
• Collaborate with Implementation and Account Management teams on issues related to group and enrollment/COBRA
• Work with external carriers/vendors to ensure member eligibility is accurately reflected
• Monitor and assist groups in our employer portal
• Manage coordination of benefits for members
• Monitor and process claims in SDS queue
• Request and evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules
• Identify potential claims impact due to eligibility updates
• Meets standard performance metrics and SLAs set for the Eligibility team

Qualifications:

Required Skills and Abilities:

• Ability to prioritize and organize own work to meet deadlines
• Ability to work within multiple systems/programs to investigate issues
• Intermediate Microsoft excel skills
• Strong customer service skills
• Strong verbal/written communication skills
• Problem solving and analytical skills
• Detail-oriented
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently
• Strong interpersonal skills, establishing rapport and working well with others
• Knowledge of benefit plans, policies, and procedures and understanding of medical terminology

Education and Experience:

• High school diploma or GED required, Associate’s or Bachelor’s degree preferred
• 1-2 years of experience in the healthcare industry is preferred, but not required

Preferred Qualifications:

• Experience working with highly automated and integrated claim adjudication system, El Dorado-Javelina and/or Health Rules Payer preferred, but not required
• Ability to interpret health plan eligibility rules as outlined in the Summary Plan Description (SPD) document
• Coordination of Benefits and Medicare knowledge
• Experience with Zelis vendor platform/ID card configuration

Work Location:

An ideal candidate would be assigned to the Buffalo, NY office with the ability to work from home. Fully remote will also be considered for strong candidates.