Eligibility Rep I-Ops
Health Net of California, Inc. - 4001 - Woodland Hills, CA

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Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net, through its subsidiaries, provides and administers health benefits to approximately 5.4 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 4.9 million individuals, including Health Net's own health plan members. Health Net's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.

For more information on Health Net, Inc., please visit the company's website at www.healthnet.com .

JOB SUMMARY:

Processes and maintains eligibility information for routine individual and/or employer groups under direct supervision.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Maintains accurate eligibility records for assigned line of business. Enters system eligibility data on a daily basis, including new enrollees, changes, and cancellations.
  • Conducts periodic audits of group eligibility data.
  • Reconciles group eligibility report to monthly statements.
  • Responds to all written and telephone eligibility inquires from individuals or assigned employer groups.
  • Researches information on subscribers to resolve problems and disputes.
  • Maintains quality and production standards as outlined by the department.
  • Assists with special projects.
Qualifications

REQUIREMENTS:

Education:

High School Diploma or equivalent required

Certification/License:

Experience:

One year general work experience required

Knowledge, Skills & Abilities:
  • Ability to operate PC-based software programs required
  • Excellent written and oral communication skills required
  • Ability to type 35 wpm and operate 10-key by touch required
  • Demonstrated problem solving skills
WORKING CONDITIONS

The following section describes the general physical requirements for this position. Please note that 'constant' refers to more than 81% of time; 'significant' refers to 40-80%; and 'moderate' refers to 20-40% of the time.
  • Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
  • Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
  • May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
  • May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
  • Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
  • Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
  • Required to have hearing ability to receive detailed information through oral communication.
  • Required to have speaking ability to express or exchange ideas.
  • Constant concentration may be required on various subjects by listening, reading and thinking clearly.
  • Constant interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
  • Constant thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
  • Constant computer usage including typing and/or eye strain.
  • Constant repetitive arm, wrist, hand and finger motions - making repetitive movements (e.g. key boarding, filing, data entry).
  • Constant phone usage; headsets may be required.
  • Significant amount of time spent working in a loud office environment with frequent interruptions/distractions.
  • Constant sedentary work (desk bound or seated).
  • Constant reading is required via computer screen and/or bound printed materials.
OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.

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