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Eligibility Specialist

5 months ago

Sandton, South Africa HR Studio Full time

We're looking for…

An Eligibility Specialist that will be able to process benefit entries and validate information. You will respond to eligibility and other enrollment related issues involving member specific information; partner directly with clients, and/or vendors, to resolve problems and achieve positive outcomes.

Who are you?

  • You are able to demonstrate the ability to use a computer with expert-level keyboard and navigation skills, as well as the ability to quickly learn new software programs.
  • You have the ability to communicate clearly and professionally with both internal and external customers.
  • You know how to maintain confidentiality and exercise discretion with sensitive information
  • You are have an eye for detail and great time management skills 
  • You are capable of working effectively both independently and as part of a team to achieve established goals. Understand the roles of others and empower team members to take responsibility for their success.

What's the role?

You will be responsible for:

  • 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 renewals 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.

Boxes to tick…

  • Matric
  • Diploma or equivalent
  • 2 years of experience in eligibility, enrollment, or benefits customer service role focused on eligibility
  • You have a strong knowledge of health insurance plans and employee benefits.
  • You have a familiarity with benefit administration platforms such as Javelina.
  • You are proficient in standard computer applications, including MS Word, Excel, Outlook, and PowerPoint.

Working Hours: 2pm - 11pm