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Eligibility Coordinator

Navia Mexico

Navia Mexico

Fresno, CA, USA
Posted on Monday, September 18, 2023

This position will work with our employer groups, brokers, vendors, carriers, and general agents on eligibility-related changes, questions, and issues. This position will require knowledge of the enrollment process for the services we provide to our employer groups, including but not limited to complex medical (MERP, HRA), dental, vision, and MEC plans. This person must represent Navia in a professional, upbeat, and knowledgeable manner via written and verbal communications.

Additionally, this position supports most other department positions and requires the person to understand the functions of their position and how it affects the department’s workflow, and how it affects each person’s actual work. This position involves very detailed individual work such as auditing, reporting, updating enrollment changes across various systems. This position requires understanding of how to process files received through sFTP server on Flexman. This position has time-sensitive work that is required and excellent organization and attention to detail are required. This position will work in a team environment to review processes and procedures to ensure departmental work is being handled efficiently.

Essential Functions
  • Reviewing emails on eligibility updates, changes, or issues
  • Entering eligibility requests as received from email or through the portal.
  • Actively identify system issues and report them to the correct departments when it disrupts eligibility
  • Creating, maintaining, and entering employee demographic information
  • Notifying other departments of eligibility changes as needed
  • Reach out to employer groups as needed to clarify enrollments
  • Review file feeds received and update eligibility information on a weekly basis
  • Provide accurate and thorough audit information to our clients, brokers or supporting departments
  • Knowledge of how to use vendor sites for eligibility enrollments and/or changes
  • Knowledge of department functions and Navia systems as required for the position
  • Meet the measured metrics for this position on a daily basis that may vary depending on the volume and complexity of eligibility changes
  • Other duties as assigned
  • Basic understanding of our MERP, HRA, Dental, Vision, MEC, CADR+ and COBRA services.
  • Comfortable working and communicating with brokers, general agents, and employer group contacts
  • Ability to meet deadlines and complete time-sensitive work
  • Basic computer skills and knowledge of Microsoft Word, Excel and Outlook
  • Good customer service skills
  • Good written and verbal communications skills
  • Good attendance
  • Professional and upbeat attitude, adaptability, and multi-tasking abilities
  • Good organizational skills and attention to detail
  • Good follow-up skills
  • Good problem-solving skills
  • Independent/self-motivated
  • Willingness to work outside scheduled work hours as needed, especially during our peak season