Eligibility Representative
Washington Dental Service 4 reviews - Spokane, WA

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Provide new group set up and maintain accurate eligibility records for clients to ensure efficient and accurate premium reconciliation. Research and follow up on incoming calls and mail inquiries regarding the processing of Eligibility and premiums.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
· Research and provide accurate and timely responses to internal and external inquiries regarding Eligibility from clients, client representative, brokers, subscribers, dental offices, Finance, Marketing, I.T., and Operations.
· Assist in identifying problem areas and recommend solutions when necessary.
· Reconcile premiums to client reporting and assist Finance in group premium distribution.
· Process eligibility records through data entry functions and via tapes and disks.
· Provide benefit information re: eligibility requirements for subscribers and dependents.
· Provide education to group representatives regarding COBRA Laws and limitations.
· Research inquires regarding duplicate coverage, COB and claims payment information.
· Set up and update the subscriber database files.
· Conduct site visits for groups and group administrators.
· Release processed claims for payment after the subscriber database is accurately updated and premiums are reconciled.

This job has no supervisory responsibilities.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· One year of insurance eligibility experience required.
· One year office experience including verbal and written communications at the business level.
· Demonstrated business letter writing abilities.
· Ten key by touch.
· Proven customer service experience working with people in problem solving situations.
· Demonstrated PC skills including data entry.
· Detail oriented with a high level of accuracy.
· Ability to meet deadlines and handle multiple tasks simultaneously.
· Proven ability to prioritize and independently plan work.
· Displayed flexibility to work well independently and in a team.

High school diploma or general education degree (GED); and one year billing/accounts receivable experience and/or training (group insurance experience preferred); or equivalent combination of education and experience.


Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.


Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.


Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.



The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to walk. The employee is occasionally required to stand. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision.


The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

About this company
4 reviews
Washington Dental Service, a member of the Delta Dental Plans Association, is the leading dental benefits company in the state of...