Coordinator II - Eligibility Consultant

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:

• 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.

Position Summary:

• 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.

Education:

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

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 MCO’s.
• Knowledge of Enrollment.
• Knowledge Medicaid and/or Medicare.
• Knowledge and comfortability with learning different systems and using Excel.

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.

Location Requirements:

• Candidates can be located anywhere in the US, but pref. EST and CST.
• Must work EST hours (preference given to EST-aligned candidates).

Hiring Process:

• Hiring Managers have hired directly off resumes in the past, subject to change.

TopofResume Candidate Screening Questions (Candidates must include these answered at the top of their resume):

• Do you have experience verifying member enrollment or updating eligibility information (demographics, dates, plan changes)?
• Have you worked with manual enrollment updates or corrections in a healthcare system (ex: QNXT or similar)?
• Do you have experience researching and resolving eligibility or enrollment discrepancies using reports or reconciliation files?
• Have you handled enrollment requests or urgent updates received via email from health plans or state agencies?
• Do you have experience working claimrelated inquiries tied to eligibility issues (ex: H03s or similar)?
• Are you familiar with Medicaid, Medicare, or Managed Care Organizations (MCOs)?
• Have you performed highvolume manual data entry where attention to detail and accuracy were critical?
• Do you have strong experience researching data issues and determining appropriate corrections independently?
• Are you comfortable learning and working across multiple systems and using Excel for tracking or analysis?
• Are you able to adapt to changing priorities and understand how your work impacts downstream teams and processes?