FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in resolving enrollment and eligibility issues while effectively communicating with health plan members and employer groups. Proficient in interpreting contractual rules and managing membership data workflows to ensure compliance with policies and procedures.
Highest-signal resume keywords
Customer Service ExperienceEnrollment Issue ResolutionClaims ProcessingCommunication SkillsData Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Membership Data ManagementEligibility DeterminationClaims ReviewData Extraction ReportsPolicy Interpretation
Soft Skills
Communication SkillsCustomer RetentionProblem Solving
Tools & Technologies
Online Employer-Group Modules
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
Health Plan EnrollmentEligibility IssuesClaims IssuesBenefit GuidelinesCustomer Service Processes
About the role
Key responsibilities & impact- Resolve and reconcile enrollment reports and related eligibility issues
- Communicate with newly enrolled health plan members, dependents and employer groups
- Interpret and apply contractual rules and regulations with employer groups and vendors
- Perform membership data extract reports for employer-group audits
- Update, approve and interpret membership data and workflows in online employer-group modules
- Determine member eligibility and process terminations and disenrollments
- Prepare and distribute enrollment-related letters to subscribers and members
- Determine coverage of services according to line of business and product design
- Review suspended claims and resolve them using applicable policies, procedures and benefits
- Support and advise member and provider services staff regarding claims issues
- Research provider claim issues and identify criteria for payment reconsideration
- Participate in cross-training and improve Customer Service team processes
Requirements
What you’ll need- High School Diploma or Equivalent (GED) (Required)
- Minimum of 1 year of customer service experience (Required)
- Communication skills
- Customer Retentions
- Customer Service skills
- Ability to resolve enrollment, eligibility and claims issues according to policies, procedures, regulations and benefit guidelines
- Ability to work 40 scheduled hours per week
- Ability to work day shifts
- Pennsylvania residency
Benefits
Comp & perks- Healthcare benefits for full-time and part-time positions from day one
- Vision coverage
- Dental coverage
- Domestic partner benefits
- Collaborative, cooperative and collegial work atmosphere