Eligibility Administrator

Summary

Imagine360 is seeking an Eligibility Administrator to join the team! The Eligibility Administrator is responsible for the accurate and timely administration of member eligibility for assigned client groups, ensuring that member enrollment information is maintained in accordance with client requirements and regulatory standards.

Responsibilities

• Process new member enrollments accurately and within established service standards
• Review and processing member terminations
• Process eligibility changes such as demographic updates, plan changes, dependent additions or removals, and status changes
• Process reinstatements when previously terminated members regain eligibility
• Process Coordination of Benefits, other insurance coverage requests
• Update COBRA eligibility in partner system
• Manage a designated portfolio of client groups and ensure all requests are completed accurately and on time
• Review plan documents, fact sheets, benefit summaries, and plan recaps to verify eligibility requirements
• Apply client-specific eligibility rules according to plan documents
• Ensure that enrollment decisions are consistent, accurate, and properly documented in file system
• Respond to eligibility inquiries from clients, brokers, and trading partners
• Research eligibility concerns and resolving enrollment discrepancies
• Collaborate with Client Experience, Member Experience, and other operational teams to resolve client concerns
• Maintain professional communication when addressing member and client concerns
• Review production metrics on a consistent basis
• Meet daily, weekly, and monthly transaction goals
• Maintain established service level and turnaround time expectations
• Achieve monthly quality score goals established by the department

Skills

• High School Diploma or GED
• 2-4 years of operations experience required or equivalent combination of education and experience
• Experience interpreting large data sets and identifying discrepancies
• Advanced Microsoft Excel skills, including data manipulation, validation, and reporting
• Proficiency with Microsoft Lists, Excel and related Microsoft Office applications
• Working knowledge of Word, PowerPoint, Visio, and Copilot
• Ability to navigate multiple systems efficiently
• Strong verbal and written communication skills
• Ability to explain complex eligibility concepts to clients and internal teams
• Professional customer service approach when handling escalated eligibility concerns
• Comfortable interacting with clients, brokers, and operational departments
• Effective time-management and prioritization skills
• High level of accuracy and attention to detail
• Strong organizational and documentation skills
• Follow HIPAA guidelines and protect confidential member information
• Adhere to established eligibility processes and operational procedures
• Maintain compliance with company standards for quality, documentation, and client service
• Participate in team meetings, training sessions, quality reviews, and continuous improvement initiatives

Qualifications

Must Haves

• High School Diploma or GED
• 2-4 years of operations experience required or equivalent combination of education and experience
• Experience interpreting large data sets and identifying discrepancies
• Advanced Microsoft Excel skills, including data manipulation, validation, and reporting
• Proficiency with Microsoft Lists, Excel and related Microsoft Office applications
• Working knowledge of Word, PowerPoint, Visio, and Copilot
• Ability to navigate multiple systems efficiently
• Strong verbal and written communication skills
• Ability to explain complex eligibility concepts to clients and internal teams
• Professional customer service approach when handling escalated eligibility concerns
• Comfortable interacting with clients, brokers, and operational departments
• Effective time-management and prioritization skills
• High level of accuracy and attention to detail
• Strong organizational and documentation skills
• Follow HIPAA guidelines and protect confidential member information
• Adhere to established eligibility processes and operational procedures
• Maintain compliance with company standards for quality, documentation, and client service
• Participate in team meetings, training sessions, quality reviews, and continuous improvement initiatives

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives
• Position Location: 100% remote