Senior Eligibility Consultant
Core
Senior individual contributor responsible for accurate, timely eligibility processing and resolution of complex enrollment and eligibility issues to support claim payment and plan sponsor service expectations.
Role type
Senior Eligibility Consultant (Individual Contributor)
Builds
Eligibility decisions and enrollment resolutions for health plans and members
Domain
Health insurance / Eligibility administration
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
Eligibility processing, complex issue resolution, root cause analysis, process improvement, mentoring, workflow management, data discrepancy evaluation
Preferred skills
COBRA/Eligibility program support, escalated case handling, transition support, job aid creation
Technologies
Administration systems
Responsibilities
Process policy and eligibility data accurately; resolve complex eligibility and enrollment issues; partner with internal teams, clients, and vendors; anticipate and prevent issues; contribute to process improvements; support reporting and data discrepancy work; design and deliver transition support for new hires; coach and mentor junior team members
Seniority
Senior, hands-on IC with mentorship responsibilities