Eligibility Specialist

Key Responsibilities:

• Manage Membership Eligibility for BCBS Members:
  Verify and maintain accurate membership eligibility information for all Blue Cross Blue Shield members. Ensure that all data is current and aligns with company and insurance policies.

• Prepare and Distribute Member Correspondence:
  Create and send termination letters, welcome letters, and physician change letters to patients. Ensure all communications are accurate, timely, and adhere to organizational standards.

• Coordinate Provider Assignments and Notifications:
  Handle pre-assignments for doctors and verify patient coverage. Notify patients of any changes to their assigned healthcare providers, including when a provider exits the organization or when a new provider is added. Assist patients in identifying new providers when necessary.

• Communicate Effectively Between Departments and Patients:
  Serve as a communication bridge between various departments within the organization and the patients. Ensure that all parties are well-informed and up-to-date regarding eligibility, provider changes, and coverage details.

• Maintain Accurate Records:
  Keep detailed and organized records of all member eligibility verifications, provider changes, and patient communications. Ensure compliance with all regulatory requirements and organizational policies.