Eligibility Specialist
EnvisionRxOptions - Twinsburg, OH

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EnvisionRxOptions, with a commitment to providing transparency and disclosure to the Pharmacy Benefit Management (PBM) marketplace, provides full service, integrated PBM services, including network-pharmacy claims processing, mail order, benefit design consultation, drug utilization review, formulary management, and other related services. If you are interested in becoming part of a team-oriented, fast-growing company we encourage you to consider a satisfying career at EnvisionRxOptions.

POSITION PURPOSE: The Eligibility Specialist is responsible for supporting the electronic eligibility functions of the company in accordance with the policies and practices of EnvisionRxOptions. This position will be responsible for loading client eligibility data files into the adjudication system while maintaining the exceptional level of professionalism and customer service standards that Envision has attained within the pharmacy benefit management industry.

  • Consult with account managers, clients and other third parties regarding the creation and transmission requirements of eligibility data files
  • Load client eligibility data files into adjudication system
  • Review client eligibility data files to ensure accuracy of exchanged information
  • Communicate with account managers, clients and other third parties regarding changes or corrective actions to ensure data integrity and format compliance
  • Understand and communicate data transmission methods, data file layouts and standards to account managers, clients and other third parties
  • Other duties as assigned
  • High school diploma or GED required; Bachelors degree strongly preferred
  • Experience managing and coordinating batch data files
  • Experience with claims processing systems
  • A knowledgeable individual with appropriate industry experience, preferably in the healthcare, insurance or PBM industry
  • Effective verbal and written communication skills
  • A strategic planner with sound technical skills, analytical ability, good judgment and strong operational focus
  • Ability to work with peers in a team effort
  • Demonstrated ability to manage multiple priorities and deadlines
  • Capability to efficiently complete tasks in a fast paced environment
  • Ability to work extended hours, weekends and holidays pursuant with industry demands
  • Proficient in Microsoft Office and industry related software programs
    Pre-employment drug screening and background checks are required. The company offers a competitive salary and benefits package. EOE

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