AMVETS Jobs

Apply today to join a company that’s culture is centered around patients, people, and communities.

We are looking for a benefits specialist to join the team.

Job Duties

· Prepares, processes, uploads, and maintains new member or group registration information in the enrollment database.

· Responds to member or group eligibility questions, including verifying enrollment status. reconciling eligibility discrepancies, analyzing transactional data, and submitting retroactive eligibility changes, as needed.

· Generates various types of member correspondence. Maintains inventory control of member and group transactions.

· Enters, scans, or updates database information for new enrollments and terminations of group, individual, and ancillary health insurance products, including group employer accounts and individual policy profiles.

· Processes demographic changes to member records, such as name/address/phone/email changes, primary care provider (PCP) changes, etc.

· Handles enrollment or eligibility inquiries from Member Services, including processing duplicate ID card requests, reprinting correspondence, and reordering new member materials.

· Reviews all pending enrollments data for accuracy, analyzes any discrepancies, obtains the correct information, and reconciles the records.

· Communicates with stakeholders (e.g., brokers; customers; vendors) to obtain information and/or clarify concerns based on initial enrollment/eligibility submissions.

· Contacts relevant stakeholders for missing information or incomplete enrollment package to determine availability of the files or forms.

· Reviews enrollment/eligibility submissions (e.g., applications; electronic files) to identify unclear, missing, or validate data, investigates enrollment/eligibility issues or discrepancies.

· Submits and reviews test or new eligibility electronic files to ensure the format and accuracy of the loaded information is correct.

· Loads information accurately using working knowledge of relevant file layouts (e.g., flexible spending accounts (FSA), spreadsheet solutions, etc.).

· Uses appropriate computer applications and tools to manage and report enrollment/eligibility.

· Enters and updates enrollment/eligibility information in the relevant databases and systems.

· Adheres to all audit controls, production standards, and regulatory requirements when loading files, resolving eligibility error, or modifying member profiles.

· Maintains strictest confidence of all patients protected health information (PHI) and protects all PHI from accidental, intentional, or inappropriate disclosure.

· Performs and/or reviews audits on enrollment/eligibility information to validate data and to identify areas requiring corrections or modifications.

Skills & Requirements

· High School Diploma or General Education Diploma (GED)

· General knowledge of health care operations and structure, basic requirements in an integrated delivery system, and the use of information system applications in a health insurance or health care environment.

· Working knowledge of health insurance concepts related to enrollment and eligibility practices.

· Basic familiarity with and understanding of the California Department of Managed Health Care (DMHC) regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships.

· Good attention to detail with time management and organizational skills, including the ability to prioritize assignments and work within standardized policies, procedures, and practices to achieve objectives and meet deadlines.

· Familiarity with relevant file layouts (e.g., Flexible Spending Accounts (FSA), spreadsheet solutions, etc.) for enrollment system uploads.

· Proficient skills with Microsoft Office Suite (Word, Excel, PowerPoint), including a general understanding of database management and data validation techniques.

· Ensure the privacy of each patient’s protected health information (PHI).

· Build collaborative working relationships with patients, prospective clients, peers, physicians, other healthcare providers, and vendors to provide exceptional customer service.

About Aston Carter:

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing® double diamond winner for both client and talent service.

Diversity, Equity & Inclusion

At Aston Carter, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email astoncarteraccommodation@astoncarter.com (%20astoncarteraccommodation@astoncarter.com) for other accommodation options.