Role Overview
The Eligibility Consultant – Paper Ops will support enrollment and eligibility operations across multiple health plans. The role is highly manual, accuracy-driven, and requires experience with healthcare eligibility, enrollment updates, and regulatory compliance.

Key responsibilities include:
Verifying and updating member enrollment and eligibility information
Manual eligibility and enrollment updates (including urgent and fall-out items)
Researching and resolving enrollment discrepancies and claim-related eligibility issues
Maintaining data integrity to prevent downstream claim and billing impacts
Partnering with internal teams to support accurate and timely enrollment processing

Position Summary:
The Contractual Eligibility Consultant is responsible to research and validate enrollment information, process enrollment transactions, make outbound calls to enrollees and members to obtain required enrollment information, handle member inquires and participate in enrollment projects. The Contractual Eligibility Consultant will support training initiatives and work to resolve member inquires or concerns.

What you will do
Handles physical documents and paper records to verify the eligibility of patients or members for healthcare services.
Reviews paper forms, applications, or supporting documentation to gather and validate information such as insurance coverage, demographic data, and eligibility criteria.
Organizes paper-based eligibility documents by creating and maintaining filing systems, ensuring proper document storage, and implementing strategies to improve accessibility and retrieval of information.
Analyzes the paper-based information and documentation to determine the eligibility of patients or members for healthcare services.
Performs manual data entry tasks to input eligibility information into relevant systems or databases.
Ensures compliance with relevant healthcare regulations, policies, and industry standards in relation to paper-based eligibility operations to maintain patient confidentiality.
Identifies opportunities to enhance the efficiency and accuracy of paper-based eligibility operations.
Follows regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and personal development.
Generates reports and analyzes data related to paper-based eligibility operations to help improve processes, address bottlenecks, and support decision-making.

Required Qualifications:
Customer Service experience.
Attention to detail and accuracy.
Problem solving skills.
Strong organization skills.
Understands the impact of work to other teams and downstream support areas.
Ability to analyze and research data to make appropriate corrections as necessary.
Strong verbal and written communication skills.
Workplace flexibility - ability to adapt to change

Preferred Qualifications:
Knowledge of Health Care and/or MCO’s.
Knowledge of Enrollment.
Knowledge Medicaid and/or Medicare.
Knowledge and comfortability with learning different systems and using Excel


Experience
At least 1 years of overall related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes or previous work experience in regulatory environment Dependable/Responsible/Accountable Excellent spoken and written communication skills Capable of managing through transition, while fostering a positive team environment Confident in decision making ability within strict timelines Exceptional prioritization and organizational skills Acts with integrity and uses sound judgment in dealing with confidential information

Position Summary
The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator II reports directly to the Enrollment Supervisor.

Education
Verifiable High School diploma or GED required; Bachelors Degree in Marketing preferred


Top 3 Skills:

1. Eligibility & Enrollment Processing Expertise
Verifying enrollment status
Updating demographics, effective/term dates, newborns, and terminations
Knowledge of Medicaid, Medicare, MCOs, and enrollment rules
Applying regulatory and legislative requirements correctly

2. Attention to Detail & Data Accuracy
Manual system updates (QNXT or similar systems preferred)
Correcting fall-out edits and reconciliation discrepancies
Reviewing finance and enrollment reports
Preventing downstream claim and billing errors

3. Analytical & Problem-Solving Skills
Researching eligibility and claim inquiries (e.g., H03s)
Analyzing reports to identify data issues
Determining the correct fix, not just applying changes
Understanding downstream impacts to other teams and systems


Notes:

Fully remote
Schedule: Monday–Friday, 8:00 AM–4:30 PM EST