Integrated Resources
Job Title: Eligibility Consultant
Location: Remote, CT 06156
Duration: 6 Months+
Pay Range: $19.10/Hour. on W2
Schedule: Monday-Friday, 8:00 AM - 8:00 PM
Position Summary:
The Contractual Eligibility Consultant supports Healthcare's enrollment operations by researching and validating member enrollment information, processing enrollment transactions, handling member inquiries, and participating in enrollment-related projects. This temporary role also includes outreach to members to obtain missing or required enrollment documentation and supports training and process improvement efforts.
Key Responsibilities:
Required Qualifications:
Preferred Qualifications:
Location: Remote, CT 06156
Duration: 6 Months+
Pay Range: $19.10/Hour. on W2
Schedule: Monday-Friday, 8:00 AM - 8:00 PM
Position Summary:
The Contractual Eligibility Consultant supports Healthcare's enrollment operations by researching and validating member enrollment information, processing enrollment transactions, handling member inquiries, and participating in enrollment-related projects. This temporary role also includes outreach to members to obtain missing or required enrollment documentation and supports training and process improvement efforts.
Key Responsibilities:
- Handle physical documents and paper records to verify member eligibility for healthcare services.
- Review applications and supporting documentation to validate insurance coverage, demographic data, and eligibility criteria.
- Organize and maintain filing systems for paper-based eligibility documentation.
- Analyze paper-based documents to determine eligibility status.
- Perform manual data entry into internal systems and databases.
- Ensure compliance with healthcare regulations and internal confidentiality standards.
- Identify and suggest improvements to paper-based processes for greater efficiency and accuracy.
- Generate reports and analyze data to support decision-making and process optimization.
- Participate in training sessions and performance feedback meetings.
- Make outbound calls to members to obtain missing or clarifying information regarding enrollment.
Required Qualifications:
- Candidates must reside in EST or CST time zones.
- Verifiable High School Diploma or GED.
- Basic skills in MS Excel, MS Word, and Outlook.
- Minimum of 1 year of experience related to CMS guidelines for Medicare Part D enrollment processes, or prior work in a regulatory environment.
- Dependable, responsible, and accountable work ethic.
- Participation in virtual trainings and meetings (camera on required).
- Completion of all required training within specified deadlines.
- Willingness to cross-train across platforms and products to support enrollment metrics.
- Adherence to all established workflows and departmental processes.
- Ability to monitor and minimize personal errors (OMT, avoidable rejections, found errors).
Preferred Qualifications:
- Strong organizational skills and attention to detail.
- Effective communication, interpersonal, and problem-solving skills.
- Ability to maintain positive working relationships and exercise sound judgment.
- Familiarity with call recording systems is a plus.