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Role Description

The Eligibility Analyst is responsible for representing commercial or government programs' eligibility and acts as a subject matter expert for department projects, Run functions, and escalated client issues. This role is responsible for mentoring and training the Eligibility Specialist.

• Serves as subject matter expert representing eligibility on file process for new and existing clients and department projects.
• Monitors eligibility mailbox and Prime Resolution daily.
• Participates in workstream meetings, assists with providing information regarding business requirements, and performs User Acceptance Testing.
• Serves as primary contact for external clients, vendors, and Prime's Client Engagement team for requests and escalated issues; responsible for facilitating timely resolution.
• Identifies and implements improvements for existing Eligibility processes.
• Participates in peak season planning and execution.
• May manage Medicaid subrogation activities including monitoring batch claim files, outgoing eligibility files, verification of letters of authority, and some claims analysis.
• Other duties as assigned.

Qualifications

• Bachelor's degree in IT, Business, Liberal Arts, Science or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED required.
• 2 years of experience in healthcare, PBM, Eligibility or claims processing.
• Must be eligible to work in the United States without need for work visa or residency sponsorship.

Requirements

• Ability to work in a collaborative team-based environment.
• Strong oral and written communication skills.
• Strong organizational and time management skills.
• Problem-solving skills with strong attention to detail.
• Ability to implement defined objectives and to act independently.

Preferred Qualifications

• Previous PBM Experience.
• Experience working in eligibility or enrollment.
• Experience with Microsoft Excel.

Benefits

Potential pay for this position ranges from $53,000.00 - $85,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.