Eligibility Specialist

Fully Remote / WFH

Who We Are

Nonstop Administration and Insurance Services, Inc. is a fast-growing health insurance organization with a firm belief that everyone should have access to high-quality, affordable healthcare. To achieve this goal, we offer an employer-sponsored group health insurance solution called Nonstop Health®

What Nonstop is Looking For

Nonstop Administration and Insurance Services is seeking an experienced Eligibility Analyst. The employee hired for this position is responsible for handling the carrier eligibility functions with accuracy for our various clients with minimal supervision and direction.

Responsibilities

Review, interpret, and correct inbound eligibility information from various sources including but not limited to:

• Enter client data into the online eligibility portal
• Enter carrier forms that are submitted by the client
• Analyze, import, and generate recurring reports for eligibility updates (from vendors)
• Report using the eligibility portal after loading recurring data
• Collaborate with various departments and assist with data reconciliation of inbound data during annual open enrollment and new client implementations
• Review and post outbound eligibility data to various sources including but not limited to:

- Carrier portals

- 834 file discrepancy reports

• Assist departments with monthly eligibility reconciliation.
• Answer outbound and inbound calls from clients when there are eligibility-related issues
• Assist members with enrollments in the online eligibility portal (e.g. member access and login).
• Assist clients' HR departments with resolutions of eligibility exceptions. You will work directly with insurance carriers to help solve eligibility issues including but not limited to:

- Erroneous loss of coverage

- Enrollments and terminations that are past the acceptable retroactive period

- Coverage Reinstatements

- Issues stemming from incorrect or misinformed transmittal data

• Review Post-Open Enrollment data.
• Educate clients on the proper use of data-driven procedures in the online eligibility portal.
• Collaborate to coordinate COBRA enrollments for individual members.
• Assist account managers with eligibility-related issues.
• Track daily time on the various assignments. You are expected to complete assigned projects and tasks in a timely manner.
• Respond to requests from all clients, members, and carriers within a 24-hour time frame.
• Other duties as assigned by the supervisor

Requirements

Required Qualifications

• 3-5 years of experience working in group health insurance administration, particularly in carrier enrollment.
• 1 year of experience in the reconciliation of monthly carrier invoices against client records.
• Minimum 3 years of customer service experience.
• Experience with COBRA, HIPAA, EDI files, Qualifying Life Events (QLE) and PHI
• In-depth understanding of Medical, Dental, and Vision group health insurance
• Ability to compose professionally written correspondence free of grammatical errors while also translating claims and insurance expressions into simple terms that members can easily understand.
• Detail-oriented and the ability to research and resolve routine issues
• Strong computer skills, proficient in Excel
• Comfortable using a MacBook and operating in a Google environment (Slides, Docs, Sheets, Gmail, etc.)
• High school diploma or GED equivalent

Required Skills

• Good problem-solving and analytical skills.
• Familiarity and fluency with technology, computers, and online services.
• Ability to remain focused and productive each day though tasks may be repetitive.
• Ability to multitask, including the ability to understand multiple products and multiple levels of benefits within each product.
• Excellent communication skills, both oral and written with an ability to self-check work.
• Task-oriented, excellent organizational skills, ability to prioritize workload.
• Service delivery expectations
• Protects operations by keeping client information confidential.
• Meet the performance goals established for the position in the areas of; efficiency, accuracy, quality, member satisfaction, and attendance.
• Willingly performs other duties or tasks as assigned and handles multiple tasks effectively and efficiently.

Compensation and Perks:

• Hourly Rate $28.85
• Full-time / Non-exempt
• Fully remote position (Work from Home/Virtual)
• Monday - Friday / No Weekends!
• 401(k) plan participation with employer-matched contributions
• Internet Reimbursement
• Education Reimbursement
• Medical, dental, and vision benefits with 100% employer-paid premiums after the introductory period is met

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer per day
• Repetitive use of fingers, hands, elbows, and arms including typing, reaching, grasping, and writing
• Ability to lift, carry, push, pull, and carry 5-30 pounds occasionally
• Hearing and speaking ability sufficient to carry on a conversation with another individual (or groups of individuals) in person and over the telephone.
• Visual ability is sufficient to read and produce printed material and information displayed on a computer screen.

Nonstop provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.