Eligibility Specialist

Now is the time to join us! 

Who are you?

The role of Eligibility Specialist is primarily responsible for interacting with clients of Personify Health. This role oversees a variety of tasks associated with analyzing, reporting, evaluating, maintaining, and validating eligibility and enrollment to secure system data integrity.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Ability to make data accessible so that the organization can use it to evaluate and understand eligibility of benefits.
• Ability to combine raw information from diverse sources to create consistent readable formats.
• Reviewing and analyzing raw data and flat files.
• Identifying file/data issues and work to create solutions.
• Using excel to run analysis on eligibility files and data.
• Running analysis to verify accuracy of eligibility files and data prior to loading.
• Submitting eligibility and/or coverage-specific information/data to downstream vendors.
• Assisting in designing, programming, testing and standardizing process/procedures for eligibility files/data.
• Running quarterly censuses to ensure no discrepancies are found regarding invalid E13 spouse pends, overage dependent children, invalid departments, invalid rating structures/billing tiers,
• invalid ID card formats based on benefits/state EE resides, life volumes, etc.
• Running a monthly census for each assigned client on the cut-off date to validate certs & departments are reflecting correctly.
• Communicating with external vendors and clients.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health Team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• High school diploma or equivalent required.
• Some University or Post-secondary Education preferred.
• Strong personal computer usage and Internet proficiency skills.
• Ability to type 30 wpm minimum with accuracy.
• 1-2 years of Eldorado (HealthPac), QikLink, or GAIS systems preferred.
• Ability to manage and interpret raw data (834 file layout) into usable information for analysts to interpret preferred.
• Basic SQL (structured query language) skills preferred.
• Understanding of FTP (file transfer protocols) preferred.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Critical thinking.
• An aptitude for accurately overseeing, reading and interpreting a large volume of eligibility records and files.
• Strong analytical and problem-solving abilities to evaluate and resolve complex data/eligibility issues.
• Excellent written and verbal communication skills, with ability to interact professionally with diverse stakeholders.
• Ability to adapt to changing priorities, workflows, and regulations in the healthcare industry.
• Collaborative attitude and willingness to work effectively in a team-oriented environment.
• Flexible with scheduling as business needs dictate
• Proficient computer skills to navigate department-specific software, perform data analysis, and use the internet.
• Strong work ethic and self-starter, able to effectively manage multiple priorities and adapt to change within a fast-paced business environment.
• Strong customer service, analytical and decision-making skills
• Ability to organize and follow-up on multiple tasks/details with accuracy and timeliness.
• Ability to effectively interact with employees at all levels of the organization and work with a variety of people from diverse backgrounds.
• Ability to learn and navigate new software quickly.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.