Eligibility Administrator

Imagine360 is seeking a Eligibility Administrator to join our team! The Eligibility Administrator is responsible for maintaining eligibility on behalf of assigned client groups in a precise and timely manner. The Eligibility Administrator is required to meet eligibility production standards set by the eligibility leadership team by processing the required transactions throughout the day, week and month for assigned workload. Position Location: 100% remote Responsibilities include but are not limited to: Examine eligibility transactions received via internal systems, email, electronic files, or client portal for new enrollments, changes, reinstatements, terminations or other assigned work. Maintain assigned group workload, ensuring all transactions are processed timely and accurately. Approve or process enrollments sent by clients, brokers or trading partners based on department policies, procedures and plan documents. Approve or process terminations sent by clients, brokers or trading partners based on department policies, procedures and plan documents. Process eligibility changes and reinstatements sent by clients, brokers or trading partners based on department policies, procedures and plan documents. Review plan documents, fact sheets and plan recaps to ensure all eligibility transactions meet plan document requirements. Utilize approved company storage system to file transaction history and documents. Process and manage qualifying events in accordance with requirements within our COBRA partner's system, when necessary. Review production metrics provided by leadership on a consistent basis throughout the month. Meet assigned goals and metrics surrounding eligibility transactions on a daily, weekly or monthly basis. Review incoming quality audits within the required turnaround time. Meet assigned quality audit monthly goal. Review and reply to eligibility emails in a professional and timely manner. Correspond with clients, Client Experience, Member Exepeirence or other departments and teams to resolve eligibility questions and issues. Participate in required training and meetings, one on one coaching sessions, and team huddles. Perform other duties and projects assigned. Perform all tasks in accordance with HIPAA guidelines. Required Experience/Education: High School Diploma or GED 2-4 years of operations experience required or equivalent combination of education and experience. Skills and Abilities High level of accuracy and attention to detail. Strong technology skills (Microsoft products). Ability to interpret large amounts of data, making sense of transactions. Strong verbal and written communication skills with the ability to resonate with others to impact positive outcomes. Team player able to collaborate with other departments. What can Imagine360 offer you? Multiple Health Plan Options Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance Parental Leave Policy 20 days PTO to start / 10 Paid Holidays Tuition reimbursement 401k Company contribution Professional development initiatives / continuous learning opportunities Opportunities to participate in and support the company's diversity and inclusion initiatives Want to see our latest job opportunities? Follow us on LinkedIn Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions. Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation Apply To This Job