As Eligibility Specialists, we are responsible for making hiring decisions based on merit. Recruitment, hiring, training, and job assignments are made without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, or any other protected classification. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including for fair chance initiatives for hiring ordinance. Additionally, we devise reports to the director of operations and determine applicant eligibility for third-party reimbursement, process data for new individuals, and ensure proper coding for insurance billing.
Core tasks:
- determine and provide initial short-term disability eligibility evaluation
- systematic initiation of new claims in support of various product types utilizing the appropriate claim adjudication system
- perform a policy coverage search to determine claim filing eligibility and process based on standard and customized policy instructions
- manage pending and completed prior to assignment to the corresponding claims organization
- identify trends, issues and innovative ideas and partner in solutions