Eligibility & Enrollment Processor 2

Title: Eligibility & Enrollment Processor 2                          Department: Technical Operations
Union: UFCW 1546                                                                 Grade: 22

Position Summary

The Eligibility and Enrollment Processor 2 supports the administration of member eligibility and enrollment activities by maintaining accurate records and responding to member and client inquiries. This role applies knowledge of assigned benefit plans to research and resolve eligibility issues and ensure accurate processing of enrollment information. The position contributes to effective customer service and supports coordination with internal teams and external vendors to maintain accurate member coverage.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities

• Maintain current knowledge of assigned benefit plan(s) and applies plan provisions when performing enrollment and eligibility functions.
• Provide customer service by responding to and documenting telephone, written, and in-person inquiries in accordance with various Plan(s) benefits.
• Maintain member and dependent files in the administration system to ensure accurate enrollment information.
• Resolve eligibility & enrollment issues with various vendors, including Preferred Provider Organizations (PPO's) and Pharmacy Benefit Managers (PBMs).
• Handle inbound and outbound correspondence, including identification cards, eligibility packets and related enrollment documentation.
• Researches and resolves complex and technical issues and irregularities.
• Respond to inquiries from examiners and billing processors related to enrollment issues.
• Perform other duties as assigned.

Minimum Qualifications

• High School diploma or equivalent.
• One year working as an Enrollment & Eligibility Processor
• Strong work ethic and team player mentality.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Solid organization skills with strong detail orientation and listening skills.
• Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.
• Proficient computer skills including MS Office tools and applications.
• Preferred Qualifications
• Experience working in enrollment administration, benefits administration, or health plan operations.
• Experience working with administrative or enrollment management systems.

*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Working Conditions/Physical Effort

• Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements.
• May be subject to interruptions.
• May be required to lift a up to 25 lbs.
• Must be able to have flexible work schedule when workflow requires.
• Must meet established attendance and punctuality guidelines.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at [email protected], and we would be happy to assist you.

Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location.

Compensation: $16.12-22.52/hr

Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before.

We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American!

We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!