Coordinator II - Eligibility Consultant –

Candidates can be located anywhere in the US, but pref. EST and CST.

Schedule: MondayFriday, 9:00 AM6:30 PM EST
Must work EST hours (preference given to EST-aligned candidates)
Bill Rate: ***/hour
Safety Sensitive: Yes
Hiring Process: Hiring Managers have hired directly off resumes in the past, subject to change

Remote Work Requirements
Private, dedicated workspace: Required
Screenshot of internet speed: Required at submission

Role Overview
The Eligibility Consultant Paper Ops will support enrollment and eligibility operations across multiple health plans. The role is highly manual, accuracydriven, and requires experience with healthcare eligibility, enrollment updates, and regulatory compliance.

Key responsibilities include:
Verifying and updating member enrollment and eligibility information
Manual eligibility and enrollment updates (including urgent and fallout items)
Researching and resolving enrollment discrepancies and claimrelated eligibility issues
Maintaining data integrity to prevent downstream claim and billing impacts
Partnering with internal teams to support accurate and timely enrollment processing

Top 3 Skills:
1. Eligibility & Enrollment Processing Expertise
Verifying enrollment status
Updating demographics, effective/term dates, newborns, and terminations
Knowledge of Medicaid, Medicare, MCOs, and enrollment rules
Applying regulatory and legislative requirements correctly
2. Attention to Detail & Data Accuracy
Manual system updates (QNXT or similar systems preferred)
Correcting fallout edits and reconciliation discrepancies
Reviewing finance and enrollment reports
Preventing downstream claim and billing errors
3. Analytical & ProblemSolving Skills
Researching eligibility and claim inquiries (e.g., H03s)
Analyzing reports to identify data issues
Determining the correct fix, not just applying changes
Understanding downstream impacts to other teams and systems

TopofResume Candidate Screening Questions (Candidates must include these answered at the top of their resume)
1. Do you have experience verifying member enrollment or updating eligibility information (demographics, dates, plan changes)?
2. Have you worked with manual enrollment updates or corrections in a healthcare system (ex: QNXT or similar)?
3. Do you have experience researching and resolving eligibility or enrollment discrepancies using reports or reconciliation files?
4. Have you handled enrollment requests or urgent updates received via email from health plans or state agencies?
5. Do you have experience working claimrelated inquiries tied to eligibility issues (ex: H03s or similar)?
6. Are you familiar with Medicaid, Medicare, or Managed Care Organizations (MCOs)?
7. Have you performed highvolume manual data entry where attention to detail and accuracy were critical?
8. Do you have strong experience researching data issues and determining appropriate corrections independently?
9. Are you comfortable learning and working across multiple systems and using Excel for tracking or analysis?
10. Are you able to adapt to changing priorities and understand how your work impacts downstream teams and processes?

Eligibility Cnslt - Paper Ops

Position supports multiple health plans:
Verify member enrollment status
Make changes to member demographics, effective and term dates
Addresses a variety of enrollment questions or concerns from the health plan / state
Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
Manually update urgent request received via email from the health plan / state
Work claim inquiries (H03s)
Manually enter temp newborns
Review and manually update all reconciliation reports received from Finance
Responds, researches, and resolves eligibility related issues involving member specific information
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
Partners with other team functions to coordinate the release of eligibility and benefit plan information.

Required Qualifications:
Customer Service experience.
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
Strong verbal and written communication skills.
Workplace flexibility - ability to adapt to change

Preferred Qualifications:
Knowledge of Health Care and/or MCOs.
Knowledge of Enrollment.
Knowledge Medicaid and/or Medicare.
Knowledge and comfortability with learning different systems and using Excel

Position Summary:

Eligibility Cnslt - Paper Ops

Position supports multiple health plans:
Verify member enrollment status
Make changes to member demographics, effective and term dates
Addresses a variety of enrollment questions or concerns from the health plan / state
Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
Manually update urgent request received via email from the health plan / state
Work claim inquiries (H03s)
Manually enter temp newborns
Review and manually update all reconciliation reports received from Finance
Responds, researches, and resolves eligibility related issues involving member specific information
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
Partners with other team functions to coordinate the release of eligibility and benefit plan information.

Required Qualifications:
Customer Service experience.
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
Strong verbal and written communication skills.
Workplace flexibility - ability to adapt to change

Preferred Qualifications:
Knowledge of Health Care and/or MCOs.
Knowledge of Enrollment.
Knowledge Medicaid and/or Medicare.
Knowledge and comfortability with learning different systems and using Excel

Duties:

Eligibility Cnslt - Paper Ops

Position supports multiple health plans:
Verify member enrollment status
Make changes to member demographics, effective and term dates
Addresses a variety of enrollment questions or concerns from the health plan / state
Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
Manually update urgent request received via email from the health plan / state
Work claim inquiries (H03s)
Manually enter temp newborns
Review and manually update all reconciliation reports received from Finance
Responds, researches, and resolves eligibility related issues involving member specific information
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
Partners with other team functions to coordinate the release of eligibility and benefit plan information.

Required Qualifications:
Customer Service experience.
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
Strong verbal and written communication skills.
Workplace flexibility - ability to adapt to change

Preferred Qualifications:
Knowledge of Health Care and/or MCOs.
Knowledge of Enrollment.
Knowledge Medicaid and/or Medicare.
Knowledge and comfortability with learning different systems and using Excel

Experience:

Eligibility Cnslt - Paper Ops

Position supports multiple health plans:
Verify member enrollment status
Make changes to member demographics, effective and term dates
Addresses a variety of enrollment questions or concerns from the health plan / state
Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
Manually update urgent request received via email from the health plan / state
Work claim inquiries (H03s)
Manually enter temp newborns
Review and manually update all reconciliation reports received from Finance
Responds, researches, and resolves eligibility related issues involving member specific information
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
Partners with other team functions to coordinate the release of eligibility and benefit plan information.

Required Qualifications:
Customer Service experience.
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
Strong verbal and written communication skills.
Workplace flexibility - ability to adapt to change

Preferred Qualifications:
Knowledge of Health Care and/or MCOs.
Knowledge of Enrollment.
Knowledge Medicaid and/or Medicare.
Knowledge and comfortability with learning different systems and using Excel

Education:

Verifiable High School diploma or GED required; Bachelors Degree in Marketing preferred