Eligibility Administrator

About Imagine360

Imagine360 is a health plan solutions provider with over 50 years of expertise in self-funded healthcare. The company has helped thousands of employers save billions on healthcare costs by delivering tailored, member-focused solutions that address the limitations of traditional PPO insurance plans.

Position Summary

We are looking for a dedicated Eligibility Administrator to join our team remotely. This role involves the accurate and timely maintenance of eligibility records for designated client groups. The candidate will be responsible for processing various eligibility transactions in accordance with production standards set by the eligibility leadership.

Key Responsibilities

• Review eligibility transactions received from internal systems, emails, electronic files, or client portals concerning enrollments, changes, reinstatements, terminations, and other tasks.
• Manage and maintain the assigned group workload to ensure transactions are handled accurately and promptly.
• Authorize and process enrollments, terminations, changes, and reinstatements submitted by clients, brokers, or trading partners, adhering to departmental policies and plan documents.
• Examine plan documents, fact sheets, and recaps to ensure all transactions comply with plan requirements.
• Utilize the approved company storage system to archive transaction histories and related documents.
• Handle qualifying events through the COBRA partner system as needed, ensuring full compliance.
• Regularly monitor production metrics provided by leadership and meet daily, weekly, and monthly transaction goals.
• Conduct quality audits within specified turnaround times and attain monthly audit objectives.
• Respond professionally and promptly to eligibility-related emails.
• Coordinate with clients and internal departments to resolve eligibility concerns.
• Engage in required training sessions, coaching, and team meetings.
• Complete additional duties and projects as assigned while strictly adhering to HIPAA regulations.

Required Qualifications and Experience

• High School Diploma or GED.
• 2 to 4 years of operations experience or an equivalent mix of education and experience.

Skills and Abilities

• Exceptional attention to detail and high accuracy in data handling.
• Proficient with Microsoft Office and similar technology tools.
• Capability to analyze and interpret large datasets and complex transactions.
• Strong verbal and written communication skills focused on fostering positive interactions.
• Collaborative team member with the ability to work well across departments.

Employee Benefits

• Multiple health insurance options available.
• Employer-paid premiums for dental, vision, short-term disability, long-term disability, and life insurance coverage.
• Parental leave policy.
• Starting with 20 days paid time off plus 10 paid holidays per year.
• Tuition reimbursement program.
• 401(k) plan with company contributions.
• Ongoing professional development and continuous learning opportunities.
• Active participation in and support of the company's diversity and inclusion initiatives.

Equal Opportunity Statement

Imagine360 is committed to providing equal employment opportunities without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Additional Information

Recruitment agencies are advised that only authorized agencies invited to work on this position will be considered. Unsolicited resumes or CVs sent by agencies or candidates will not result in any fee payment.