Eligibility Specialist

4 weeks ago


Sandton, South Africa HR Studio Full time

We are seeking an Eligibility Specialist to join our team at HR Studio. In this role, you will be responsible for managing eligibility additions and terminations, ensuring enrollments and changes comply with legal requirements and client specifications, and collaborating with providers, vendors, and internal departments to resolve billing or technical issues related to eligibility.

Key Responsibilities:
  • Manage eligibility additions and terminations
  • Changes for new and renewing clients using electronic files, paper forms and portals
  • Ensure enrollments and changes comply with legal requirements and client specifications
  • Confirm that enrollments are activated promptly and that information is accurately and fully entered
  • Ensure all necessary data for transfers to affiliated vendors is included
  • Provide feedback on eligibility processing during implementations and renewments to enhance processes, workflows, and products
  • Collaborate with providers, vendors, and internal departments to resolve billing or technical issues related to eligibility
  • Create and maintain system logins for Brokers and Clients
  • Respond to client inquiries and manage data transfers, adhering to department turnaround times and maintaining queue levels
  • Assist the team in reviewing system configurations and processes to ensure optimal processing
  • Audit and validate ID card processing, and generate and mail required notices for all product lines
Requirements:
  • Matric or Diploma or equivalent
  • 2 years of experience in eligibility, enrollment, or benefits customer service role focused on eligibility
  • Strong knowledge of health insurance plans and employee benefits
  • Familiarity with benefit administration platforms such as Javelina
  • Proficient in standard computer applications, including MS Word, Excel, Outlook, and PowerPoint
Working Hours:

2pm - 11pm



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