Systems and Eligibility Specialist

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Description

WHO WE ARE

We are a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.


HERE IS WHAT WE ARE LOOKING FOR

We are seeking top talent to fill the role of a Systems and Eligibility Specialist. The primary responsibility of the Systems and Eligibility Specialist position is to perform a variety of routine and complex administrative, technical and professional work in analyzing and administering the various components of the employee benefits programs offered to clients, all while maintaining a very high degree of confidentiality.


HERE IS WHAT YOU WILL BE DOING

  • Coordinates and prioritizes activity within the eligibility unit to ensure timely completion of client eligibility updates.
  • Maintains client eligibility in various eligibility systems for clients including processing client changes, qualifying events, new hires and terminations.
  • Adheres to quality standards, deadlines and proper procedures when reviewing and updating eligibility.
  • Acts as the subject matter expert on eligibility systems.
  • Enters and updates retirement plan trust accounting system.
  • Answers emails, telephone calls, and/or written correspondence related to clients’ eligibility in a timely manner.
  • Inputs data to establish and maintain all employee benefits enrollments, changes, and terminations for all benefit plans offered by each client.
  • Identifies, researches, and resolves participant benefit issues relative to eligibility and enrollment.
  • Produces and/or reviews client invoices for clients who are using outsourcing and administration services.
  • Researches and resolves client billing issues to ensure timely payment of monthly premiums.
  • Assists with managing data within client management system and accounting system including managing the integration between the two systems.
  • Acts as vendor liaison for commission tracking issues.
  • Uses accounting and commission tracking system for invoicing and billing clients as necessary.
  • Provides billing and commission reconciliations as required.
  • Monitors and reviews data completion levels within client management system and provides updates as appropriate.
  • Maintains systems related to client management, enrollment and eligibility throughout year including employee data, rates, eligibility, plan information and contact information.
  • Works with other Relation business units to install and maintain required eligibility systems.
  • Trains new employees on the eligibility systems available to clients.
  • Other duties and projects as assigned.

Requirements

HERE IS WHAT YOU NEED TO BE SUCCESSFUL

  • A Life, Accident and Health License from the state of domicile is required within 90 days of hire and must be maintained thereafter. 
  • High school diploma or its equivalent.
  • 3-5 years’ experience in the insurance industry (or similar) and customer service.
  • Must have experience and familiarity with multiple benefit eligibility and billing systems.
  • Must be able to handle a high level of calls in a fast-paced environment.
  • Working knowledge of the laws and regulations associated with HIPAA.
  • Basic understanding of health insurance plans and enrollment processes: medical, dental, life, long-term disability (LTD), short-term disability (STD), accidental death and dismemberment (AD&D), vision, etc.
  • Advanced skills in Microsoft Office (primarily Excel and Word). Must be computer literate with the ability to learn new software applications.
  • Detail-oriented and highly organized, with the ability to manage multiple tasks and prioritize work effectively.

Note: This is an abbreviated version of the position description. 


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

  

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Relation, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is presented within this posting. 

 

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.