Eligibility Specialist

Job Summary:

We are seeking a detail-oriented and proactive Eligibility Specialist with experience in healthcare claims or insurance settings. The Eligibility Specialist will be responsible for verifying member eligibility, resolving coverage issues, coordinating with internal teams, and ensuring accurate claim processing. The ideal candidate should have strong analytical skills, excellent communication, and the ability to work in a fast-paced, deadline-driven environment.

Key Responsibilities:

• Verify member eligibility, benefits, and coverage information across multiple insurance platforms.
• Process and review eligibility requests for accuracy and completeness.
• Investigate and resolve eligibility discrepancies or coverage-related issues that impact claim processing.
• Coordinate with healthcare providers, insurance carriers, enrollment teams, and claims departments to obtain required information.
• Update and maintain eligibility data in internal systems with a high level of accuracy.
• Support the claims team by providing timely updates on eligibility status.
• Handle confidential member data in compliance with HIPAA and organizational policies.
• Respond to internal and external inquiries regarding member eligibility and benefits.
• Assist in resolving claim denials related to eligibility issues.
• Prepare reports and documentation as needed.

Preferred Skills & Qualifications:

• Bachelor’s Degree or equivalent experience in Healthcare Administration, Insurance, or a related field (preferred).
• 1–3 years of experience in eligibility verification, healthcare claims, insurance processing, or a similar role.
• Working knowledge of healthcare insurance terminology (HMO, PPO, Medicare, Medicaid, COB, EOB, etc.).
• Experience using eligibility portals, claims systems, EMR/EHR, or enrollment platforms.
• Strong attention to detail and problem-solving abilities.
• Excellent verbal and written communication skills.
• Ability to multitask and work efficiently in a high-volume environment.
• Proficiency in MS Office tools (Excel, Outlook, Word).

Job Types: Full-time, Contract

Pay: $16.00 - $22.00 per hour

Benefits:

• Health insurance
• Paid time off

Work Location: Hybrid remote in Nashville, TN 37243

Salary : $16 - $22