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Guardian Life Insurance is hiring a

Eligibility Specialist I

Eligibility Specialist I – (21002832)

Primary Location: United States

Job: Operations

Schedule: Full-time

Shift: Day Job

Job Type: Standard

Travel: No

Position Summary

Under general supervision, the Eligibility Specialist is responsible for working with representatives from client organizations and Avesis Account Managers, Customer Service and Claims department staff regarding determination of member eligibility for Avesis vision, dental and hearing program services. The Specialist receives electronic and paper documentation of eligibility from client organizations and ensures that Avesis systems for claims and customer service are updated in an accurate and timely manner. The Eligibility Specialist works closely with the Avesis Information Technology (I.T.) department to review EDI reports for accuracy and audits those files to ensure accuracy of individual membership data. The Eligibility Specialist also uses company systems applications to receive, research, and resolve eligibility inquiries in accordance with defined procedures and protocols. Periodically, the Specialist may be required to assist with billing and documentation of such actions in the Avesis systems in individual accounts.

You are

Highly motivated and detail oriented with an emphasis on customer service and team work, this position could be a great fit. Additionally, an individual with strong verbal and written communication skills and the ability to work in a fast-paced environment to meet deadlines will have an edge for success.

You have

  • High school diploma or GED high school equivalency certificate
  • Two (2) to three (3) years’ experience in enrollment processing or related experience with Electronic Data Interchange and eligibility related issues.
  • Strong Data Entry skills
  • Skill in Microsoft Office applications and Windows-based computer platforms
  • Knowledge in SQL queries and database procedures preferred
  • Effective oral and written communication skills required
  • Well organized, detail oriented, and able to adapt to procedural and other business information changes

Qualifications

You will

  • Receive electronic files of member eligibility, review for discrepancies, and update Avesis systems files as applicable
  • Process eligibility files into company membership database using current industry standards relative to HIPAA and 834-type file transmissions
  • Maintain enrollment spreadsheets for tracking and statistical purposes
  • Communicating clearly and effectively with representatives of contracted health plans and client organizations
  • Perform audits of group administration services relating to enrollment and eligibility records for commercial and government groups, process ID card requests, and perform other enrollment-related functions.
  • Other duties as assigned

Reporting Relationships

  • As our Eligibility Specialist, you will report to our Eligibility Supervisor.

Location

  • Remote
  • Office is in Phoenix

Travel

  • 0% of travel required for this role.

Location & Vaccination Requirements

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  • Covid – 19 vaccinations required for this position.

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

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.