Eligibility Representative

Eligibility Representative

Job Description

The Eligibility Representative is responsible for performing analytical and administrative functions to support Medicare enrollment and eligibility processes. This position is data-driven and transactional in nature, with a strong focus on accuracy, compliance, and Medicare requirements rather than customer-facing activities.

Key Responsibilities
Process and maintain eligibility and enrollment transactions, including updates, corrections, and reconciliations of member data
Review and analyze eligibility reports to identify discrepancies and ensure accurate resolution
Implement and maintain data across automated systems, direct connections, and manual workflows
Verify eligibility and ensure compliance with Medicare guidelines and regulatory requirements
Partner with internal teams (e.g., systems, operations) to investigate and resolve data or processing errors
Perform detailed data entry and validation tasks with a high level of accuracy and timeliness
Monitor transaction outputs to ensure completeness and adherence to established standards

Important Role Clarification
This role is not primarily customer service-based and does not focus on call handling. This role is customer focus , not customer service . We don’t speak to members at all really.
Responsibilities center on processing enrollment transactions and eligibility data, which require strong analytical skills and attention to detail
Verifying eligibility and processing enrollment applications/transactions are distinct functions, with this role emphasizing transaction processing and data integrity

Required Qualifications
Working knowledge of Medicare Advantage enrollment and eligibility (Part A, Part B, and Part C)
Strong analytical and problem-solving skills with a data-focused mindset
High attention to detail and ability to manage large volumes of transactional work
Proficiency in Microsoft Office Suite (especially Excel)
Ability to work independently with minimal supervision
Strong written communication skills for internal collaboration

Preferred Qualifications
1+ year of experience in healthcare insurance
1+ year of experience in enrollment and eligibility processing (Medicare Advantage preferred)
Prior experience with data entry, enrollment systems, and transaction processing

Notes:
This role is configured for B-Flex time entry (not SPARK) and is fully remote.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.