Eligibility Specialist I

Join us for an exciting career with the leading provider of supplemental benefits!

Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Avēsis is looking for a detail-oriented and driven candidate to assist the Eligibility Team with Commercial and/or Government enrollment operations. This position will report directly to the Supervisor of New Business Services and will work alongside several team members, including the Team Lead. The Eligibility Specialist I will be responsible for learning all relevant internal systems, along with industry eligibility requirements and expected turnaround times to process new enrollments, handle change requests, and terminate current enrollments. Additional tasks include triaging emails to appropriate team members, assisting with exception reports and collaborating with internal departments regarding specific enrollment inquiries. It is important to promote customer service and drive effective communication to generate a memorable experience and sense of care to the member and/or group.

Core Competencies

• Collegiality: building strong relationships company-wide, approachable, and helpful, ability to mentor and support team growth.

• Initiative: readiness to lead or take action to achieve goals.

• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.

• Member-focused: going above and beyond to make our members feel seen, valued and appreciated.

• Detail oriented and thorough: managing and completing details of assignments without too much oversight.

• Flexible and responsive: managing new demands, changes, and situations.

• Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.

• Integrity & responsibility: acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.

• Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Job Responsibilities include:

• Support vision and dental clients, along with brokers and general agents with daily administrative duties, including new member adds, terminations and demographic changes.
• Apply common processing rules within business, like overage dependent limits, student verification process, IRS Disability rules, SB51 (Texas) and other rules as needed.
• Determine the differences between Employer Paid groups versus Voluntary groups and apply the correct processing rules.
• Recognize the acceptable and approved applications for processing enrollments to meet underwriting guidelines.
• Identify the different Qualifying Events for member terminations and additions, which are requested outside of Open Enrollment period and take the appropriate action.
• Proficient in Outlook to support and organize a shared inbox with multiple team members.
• Triage and assign emails to appropriate stakeholders, develop comfortability with high email volumes entailing a wide range of requests, identify missing details, and initiate the necessary outreach to complete request.
• Maintain a minimum of 60% accuracy focused on quality within each enrollment request.
• Complete at least 5 emails per day, while building confidence to effectively triage emails and meet department turnaround time of 5 business days.
• Collaborate with internal departments including Account Management, Sales, and Implementation, to resolve enrollment related issues, increase levels of engagement, and discuss new process opportunities.  
• Other duties as assigned that will impact client satisfaction, improve department performance, and drive a quality brand.

Qualifications

• College degree preferred, high school diploma or equivalent required.
• Basic knowledge in Microsoft applications, 2 years of experience in Excel and Word, including creating, filtering, and formatting spreadsheets and templates.
• 1-2 years of experience in the health plan industry, including working with highly confidential information
• Experience in the health plan eligibility sector
• Must have attention to detail and multi-tasking skills.
• Experience working in a fast-paced environment to meet strict deadlines
• As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.
• Strong keyboard skills, averaging 60 WPM.

FLSA Status: Hourly / Non-Exempt

National Salary Range: $15.20 - $23.73

How To Stay Safe:

Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during our process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

Equal Employment Opportunity

At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avēsis, We See You.  We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic.  At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients.  We focus on recruiting, training and retaining those individuals that share similar goals.  Come Dare to be Different at Avēsis, where We See You!