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Eligibility Coordinator

  • Sun, August 07, 2022 2:17 AM
    Message # 12875719
    Anonymous member (Administrator)

    Full Job Description

    The Eligibility Coordinator is a hands-on position which requires a highly motivated individual who is responsible researching and resolving health and welfare benefit administration issues, requests, and escalated inquiries for internal departments, contributing employers and employees.


    • Ensure compliance with applicable federal, state, and local laws, regulations, and collective bargaining agreements related to benefits administration for Health and Welfare Fund.
    • Provide customer service for escalated eligibility inquires or issues of health and welfare benefits for employers and employees as well as medical, prescription drug, dental, vision, disability and life claims via telephone, email, letter, and fax as applicable.
    • Initiate contact with the appropriate resources and personnel to obtain information to resolve participant or employer concerns or inquires.
    • Review required and official documents (QMSCO, life death claims) for accuracy before processing by the Eligibility Department and Management.
    • Assist Eligibility Manager with onboarding new contributing employers from set-up of benefits, enrollment of employees and billing of contributions for elected coverage. Work with internal departments to track eligibility process to completion.
    • Responsible for keeping the Eligibility Department standard operating procedures up to date.
    • Investigate and prepare appeals for employers, employees, medical, dental, vision and disability for review by the Board of Trustees.
    • Review and process data for annual Medicare Subsidy filing for approval by the Director of Operations.
    • Responsible for employer and vendor HIPAA 834 files that includes demographic information on the employee, eligibility, and benefit information that will add, remove, or update an employee's enrollment information.
    • Work collaboratively with the Eligibility Department to ensure the weekly HIPAA 834 files from employers are processed, reviewed and all reported failed records are corrected and resubmitted.
    • Responsible for tracking weekly vendor and employer exceptions reports from HIPAA 834 files.
    • Processes all rejection reports associated with each vendor and employer file, correct rejected transactions, and resubmit on the next 834 file. Evaluates the data, provide results to the Eligibility Manager, and recommends the appropriate course for resolution.
    • Point of contact for implementation of new HIPAA 834 files from contributing employers.
    • Point of contact to resolve benefit administration system issues and inquires between the Fund and employers, Self-Pay and COBRA participants.
    • Respond to email, phone calls and support requests from the internal team and employers seeking help with benefit administration system or related issues.
    • Document, track, monitor and escalate support requests from employers to ensure a timely resolution.


    • College degree in business administration or equivalent.
    • 5 or more year of Health and Welfare benefits administration preferred
    • Intermediate to advanced Excel and Microsoft project skills
    • Ability to communicate (written, verbal and telephone) in a professional, positive, and courteous manner and build loyalty and strong relationships with peers, management, employers, and union representatives
    • Analyze department trends and performance to identify greater efficiencies and better understand process bottlenecks and inconsistencies throughout the entire Employer lifecycle
    • Ability to analyze situations, make appropriate recommendations and work as a team player
    • Ability to synthesize data for presentations and present it in a comprehensive and understandable manner
    • Experience in creating, maintaining, and communicating metrics that impact the realization of team goals

    Job Type: Contract

    Pay: $70,000.00 - $85,000.00 per year


    • 8 hour shift
    • Monday to Friday

    Work Location: One location

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