Document Processor (Troy, MI)

Summary – The Eligibility Processor will review and process eligibility inquiries as well as determine, maintain, and terminate member and/or dependent eligibility for healthcare benefits. Processors provide support to the healthcare service team, supervisors, and manager, when necessary.Essential Duties And Responsibilities Include But Not Limited To Understand the plan rules for eligibility as outlined in the Summary Plan Description (SPD)Process month end reportingUse reports to determine eligibility, reinstatement, or termination of coveragePrepare & mail enrollment packages and ID cards for newly eligible membersReview calc reports and exception reports to update eligibility, as neededQA self-payment notices, COBRA notices, status slips, member/dependent letters to ensure accurate information and timely mailing to participantsProcessing eligibility documents in OnBase for clientsNew member formsVital information formsMedicare information formsOther insurance information formsMember/dependent PHIACH authorizationDeath notificationsQualified Medical Child Support Order (QMSCO)Eligibility appealsLoss of time creditsEnrollment escalation requests (call center resolution form)Vendor file approvalsVendor discrepancy reportsEvaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rulesProcess payments for health & welfare coverageRequest missing information from membersProcess eligibility escalations within 24 hours and call back members with updates, as neededWork with the pension department to ensure H&W deduction amounts are correct and properly set up for retired members and surviving spousesResponsible for class code and coverage changes when member’s status changes, such as adding/terming dependents, disability, retirement, or deathUnderstand Medicare rules and regulations to determine eligibility for Medicare benefits and update coordination of benefits in appropriate systemsVerify and maintain employee demographic information, such as member or dependent address, contact numbers, birth date, social security number, or MBI numberComment system with appropriate updates based on documentation receivedReview and approve any plan changes, such as H&W rate changes, eligibility rule changes, or benefit changes with a vendorMeet daily/weekly quota requirements set by management teamUpdate Redbook when necessary; within 24-48 hours of change notificationBe knowledgeable of policies, procedures, and coverage of various fundsRegular and predictable attendance is an essential function of this jobQualifications - Excellent Multi-tasking Skills Are a Must.Preferred Qualification - Spanish speaking.Education and/or Experience – High school diploma or GED and one year of eligibility experience.Language Skills – Must speak clearly and professionally. Ability to understand directions and follow them to completion of requested task.Mathematical Skills – General math skills.Reasoning Ability - Ability to apply common sense to carry out detailed written or verbal instructions.Work Environment - Fast-paced department. Must be able to work independently as well as in a team, must be able to multi-task and detailed oriented.Work Schedule - Full time. Monday - Friday, 7:30am - 4:30 pm. Requires in-office days but also offers at-home flexibility after 90 days.Competitive Benefits And Compensation Package 12 paid holidaysPaid Time Off (PTO)Pro-rated during first year of employment15 days of PTO provided in the next calendar year!3 days paid bereavementUp to 20 days paid jury leave Medical, dental, and vision insurance, with option for dependent coverageCompany-paid basic life, short-term disability, long-term disability, and AD&D insurance401k with employer matchTuition reimbursement programCareer development opportunitiesReferral bonus for all successful full-time referralsAnnual opportunities for increasesPay - The pay for this position is $23.00 an hour. Actual salary is dependent on skills, experience, education, and other business factors.Our CultureBeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.Our culture focuses on three core values:Collaboration: working together across 31 locations to achieve the best for the company and our clientsDedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues Integrity: doing what we say we will do. Upholding strong ethical and moral principlesADA & EEOReasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.