Eligibility Specialist II

Johnson Service Group (JSG) is seeking an Eligibility Specialist.

Remote- Candidates must live in California.

Work Schedule: Monday - Friday (8:00am- 5:00pm)

Hourly pay: $18.75

Job Description Summary

This position reports to the Supervisor I, Enrollment and Eligibility. The Covered CA for Small Business (CCSB) Eligibility Specialist II is responsible for determining and managing the eligibility of employees for various benefits programs within the CCSB exchange. This role involves evaluating employee eligibility, processing benefits enrollments and terminations, and providing support to employees regarding their benefits options. The incumbent ensures compliance with company policies and legal regulations.

Qualifications

• High School diploma or equivalent and/or three (3) to five (5) years of accounting/business experience preferred.
• Intermediate knowledge of generally accepted health care eligibility and billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), California Continuation Benefits Replacement Act (Cal-COBRA) and Employee Retirement Income Security Act (ERISA) legislation.
• Proficient experience with Microsoft Office Suite.
• Proficiency in HR and benefits management software preferred.
• Strong knowledge of processing Electronic Data Interchange (EDI) file updates in a legacy system.
• Experience providing customer service to a variety of client contacts via email and telephone.
• Demonstrated ability to research and resolve technical issues and/or client problems as they arise with minimal direction.
• Written and oral communication skills including modern business communications, formatting of professional letters, reports, and phone etiquette.
• Demonstrated time management skills including, multi-tasking, working under pressure and deadlines, and working independently with minimal supervision or in a team environment.
• Intermediate knowledge of health insurance operations and industry.
• Fluent in Spanish, both verbal and written a plus.
• Ability to work overtime based on department needs and compliance.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
  
  

Duties And Responsibilities

Team Development

• Provide guidance, feedback, and support to new team members with processing challenges.
• Support new hires training by shadowing new employees as they learn the processes.
• Provide backup as a subject matter expert for new employees, fostering an outward mindset to support their growth and development.
• Identify training deficiencies and provide feedback to administration leads, promoting a culture of outward thinking to support continuous improvement.
• Collaborate with team members to understand their training needs and challenges, encouraging mutual support and development.
• Inspire proactive communication and innovative solutions to address training gaps, ensuring the success and growth of the team.
  
  

Department Operations

• Maintain Eligibility and Billing for CCSB accounts as assigned including clients that submit eligibility electronically.
• Administer and maintain benefits plans, ensuring compliance with legal and regulatory requirements.
• Process benefits enrollments, changes, and terminations accurately and timely.
• Review and process all manual and/or EDI enrollment transactions (adds, changes, terminations) in the system of record as received from the client or internal sources in accordance with Participation Agreements, Employer Policy Statement, Eligibility Guidelines, and/or Summary Plan Descriptions.
• Provide support to CCSB Small Business call center team based on business needs, ensuring efficient and effective customer service operations.
• Meet production and audit metric goals as set forth by management.
• Review audit results and make corrections within the processing cycle time standards and due dates as set forth by management. Provide timely and effective Customer Service to clients for requests, inquiries or issues concerning enrollment and/or billing items on their account.
• Communicate effectively with internal departments and external vendors, brokers or other business contacts to coordinate interrelated activities and to resolve eligibility and/or billing issues as they arise.
• Become the subject matter expert for troubleshooting issues and escalations. Act as point of contact for client escalations.
  
  

Process Improvement & Cost Containment

• Assist and support in the development of procedural strategies and operations processing including department policies and guidelines.
• Collaborate on documenting processes that will reduce data entry errors.
• Prepare and maintain benefits-related reports and documentation.
• Assist in the process for all Standard Operating Procedures (SOP) to be updated according to changes made in the process throughout the year.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
• Identify, initiate, and implement at least one process improvement and/or innovation annually.
  
  

Monitor and communicate to management processes deficiencies and recommended solutions.

• All other duties as assigned.
  
  

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law. #D800