Eligibility Specialist

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

• Process eligibility data including new enrollments, changes, terminations, COBRA events, and dependent verifications.
• Review and reconcile eligibility files from employers, unions, and payroll systems.
• Ensure data integrity by validating input and resolving discrepancies with internal systems and external partners.
• Maintain confidentiality and security of personal and health information in accordance with HIPAA regulations.
• Respond to eligibility-related inquiries from plan participants, client HR teams, and insurance carriers via phone, email, or secure messaging.
• Support monthly and quarterly audits of eligibility data and resolve identified discrepancies.
• Coordinate with IT and system vendors to address EDI transmission or interface issues (e.g., FTP transfers, 834 files).
• Prepare reports and summaries for internal departments and clients as needed.
• Assist with open enrollment, special enrollment periods, and other eligibility-related projects.
• Stay up to date on plan changes, legal updates, and industry standards related to benefits eligibility.

Qualifications

• 1–3 years of experience in benefits administration, eligibility processing, or a related healthcare or insurance environment.
• Experience in a third-party administrator (TPA) setting is highly desirable.
• Proficient in Microsoft Office Suite (Excel, Outlook, Word).
• Familiarity with eligibility systems and EDI file formats preferred.
• Excellent attention to detail, accuracy, and documentation.
• Strong organizational and time-management skills.
• Effective written and verbal communication skills.
• Ability to work independently and collaboratively in a team setting.
• Working knowledge of HIPAA and ERISA is a plus.
• High school diploma or GED required; Associate’s or Bachelor’s degree preferred.

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.