You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking an Eligibility Analyst responsible for hands-on operational support and project management related to member eligibility. This role acts as the point person for eligibility-related matters, including researching and resolving questions, communicating health plan eligibility standards, and supporting projects related to member eligibility and participation growth.

Responsibilities / Job Duties

• Acts as the eligibility SME and point-of-contact for eligibility reporting and issues.
• Manages, monitors, and reports on operational responsibilities for eligibility.
• Maintains collaborative partnerships with vendors and Benefits Administrative Office teams.
• Supervises and monitors weekly eligibility files for accuracy.
• Administers manual processes as needed and addresses file discrepancies.
• Runs weekly benefit scans and manages change and election queues.
• Manages communications for eligibility-related topics and member outreach.
• Establishes procedures to ensure accuracy, efficiency, and regulatory compliance.
• Conducts research to identify gaps and discrepancies and proposes solutions.
• Ensures compliance with health plan federal, state, and local regulations and standards.
• Partners with technical teams to optimize software platform efficiency for benefit eligibility.
• Cross-trains with other functions to provide operational support as needed.

Minimum Education and Experience Qualification Requirements

Education

• Bachelor’s degree in healthcare administration, business, finance, operations, or a related field, or equivalent work experience.

Qualifications

• 5+ years of experience in data analysis and management, project management, and operational duties in business operations or healthcare.
• Experience in audit and billing procedures, enrollment activities, and eligibility rules including COBRA and HIPAA.
• Proficient in Microsoft Office, specifically Excel (VLookup, filtering, analytical tools and formulas).
• Experience in health plan rules and exceptions, and member care or employer outreach.
• Knowledge of employee benefit plans and related regulations (ERISA, DOL, IRC, HIPAA, ACA, etc.).

Skills

• Technical proficiency in Microsoft Office applications.
• Strong analytical and problem-solving skills.
• Effective communication and teamwork abilities.

Schedule / Shift

Business hours Mon-Fri

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Our client is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or veteran status.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients