Eligibility Specialist

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Imperial Management Administrators Services

Handling internal and external inquiries regarding eligibility status, benefits, co-payments, co-insurance, deductibles, etc. thru internal system, plan website, designated portals and/or thru direct contact with the plans; Documenting inquires and responses in the system and making changes to member records per department policy and guideline.

ESSENTIAL JOB FUNCTIONS:

1.    Will create monthly eligibility lists for distribution to delegated IPA’s.

2.    Answer phone calls.

3.    Fixes EDI errors “Member Can’t Finds”.

4.    Documents member notes on the system for claims and um dept. to see if member is eligible.

5.    Maintain accurate information on members eligibility.

6.    May load new member or group data into the enrollment database and update the database with changes.

7.    Answering emails from providers, claims or UM if member is eligible or to add a new member in the system.

8.    Utilizes available resources to verify and document co-payment, coinsurance and deductible amounts due at time of service.

9.    Updates eligibility information – makes additions, changes, and terminations timely and accurately

EDUCATION/EXPERIENCE:

2 yr EZ-Cap exp

2 yr exp Technical specialty related to file formats adhering to 837, 270 & 271

To apply for this job please visit forms.office.com.