Eligibility Analyst
Job ID: MG380300910
Job Category: Customer Service
Job Location: Harrisburg, PA
Pay Range: $20.80/HOUR
Job Type: Contract
Position Overview:
We are seeking a detail-oriented and analytical professional to join our team as a Benefits Eligibility Analyst. This role is responsible for researching, validating, and reconciling eligibility data to ensure the accuracy of member records. The Benefits Eligibility Analyst will support internal and external stakeholders, resolve discrepancies, and maintain strict compliance with HIPAA and Fund Privacy and Security standards.
We are seeking a detail-oriented and analytical professional to join our team as a Benefits Eligibility Analyst. This role is responsible for researching, validating, and reconciling eligibility data to ensure the accuracy of member records. The Benefits Eligibility Analyst will support internal and external stakeholders, resolve discrepancies, and maintain strict compliance with HIPAA and Fund Privacy and Security standards.
Key Responsibilities of a Benefits Eligibility Analyst:
- Research and reconcile data to validate accuracy and determine proper entry based on established procedures.
- Review and resolve complex data issues to ensure member record accuracy.
- Identify and reconcile discrepancies in accordance with documented procedures.
- Respond to inquiries via inbound phone calls, email, and correspondence from Commonwealth personnel, Independent Agencies, Benefit Services, and internal staff—resolving issues through to completion.
- Perform member verifications in compliance with HIPAA and Fund Privacy and Security policies.
- Support internal personnel regarding eligibility changes.
- Reconcile discrepancies between PEBTF’s eligibility file and Commonwealth, SERS, and participating vendors; document and report inconsistencies to support vendor billing and data integrity.
- Review policies and procedures, providing input for clarification or improvement.
- Work overtime during peak periods, as required.
- Perform other duties as assigned by management.
Qualifications:
- High school diploma or equivalent.
- 2–4 years of data entry experience, including batching and identifying system errors.
- Knowledge of healthcare eligibility policies, procedures, and systems.
- Familiarity with health insurance programs, including Indemnity, HMO, POS, PPO, Medicare, Medicare Supplemental, Vision, Prescription, Dental, Hearing Aid, and MRP plans.
- General business knowledge.
- Strong verbal, written, and listening communication skills.
- Excellent analytical, organizational, and problem-solving skills.
- Strong interpersonal skills with the ability to work independently and collaboratively.
- Proficiency with Microsoft Office (Outlook, Word, Excel).
- Strong keyboarding and data entry accuracy skills.
- High attention to detail and ability to follow through on initiatives.
Why Join Us?
- Opportunity to play a critical role in maintaining accurate member records and data integrity.
- Collaborative environment working alongside Commonwealth agencies and benefit service providers.
- Professional growth potential within a stable and structured organization.