Eligibility Research Representative
ASH Companies - Southlake, TX

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The primary function of this position is to research and resolve eligibility verification requests in an appropriate and timely manner.

Responsibilities include:

· Researches and resolves member eligibility requests. Must maintain minimum production levels with no less than 98% accuracy.

· Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected.

· Verifies member eligibility from eligibility tape, communications log, health plan websites or by calling the health plan directly when all other resources are exhausted.

· Inputs and saves verified member’s information into the communications log and/or member maintenance.

· Ensures the highest quality of customer service by maintaining a professional and courteous manner.

· Processes research immediately to ensure turn around time is met.

· Makes follow up calls same day to providers and members to give results of research.

· Transfers providers to provider queue if question is not related to eligibility.

· Transfers members to member queue if caller has detailed questions or wishes to file a complaint.

· Processes research within 24 hours to ensure 48 hour turn around time is met.

· Builds or updates member and group records including documentation in notes.

Education/Training/Experience/Licenses

· High School diploma or equivalent.

· Two years experience with 10 key, typing, and computer skills. 8,000-10,000 key strokes per hour.

· Excellent customer service skills, experienced in making outbound calls and meeting expectations for productivity and accuracy required.

· Experience with claims processing or eligibility verification preferred.

Knowledge/Skills/Abilities:

· Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.

· Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.

· Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

· Ability to effectively organize, prioritize, multi-task and manage time.

· Demonstrated accuracy and productivity in a changing environment with constant interruptions.

· Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.

· Ability to exercise strict confidentiality in all matters.

Mobility: Primarily sedentary, able to sit for long periods of time.

Physical Requirements: Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility, within region, and nationally by car and plane as needed. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions: Usual office setting.

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