Eligibility Senior Specialist

Job Specific Accountabilities

• Develop and implement the configuration process of beneficiary benefits as per the eligibility policies in the CNHI systems for effective administration
• Define and document product configuration rules and dependencies to support the beneficiary eligibility process
• Develop and maintain configuration quality standards, policies, and procedures and ensure the mechanism runs efficiently in adherence to them
• Ensure all the healthcare benefit plans, updates / changes in policies and eligibility criteria are documented to process and administer accurately in the systems
• Monitor and verify the uploading process of latest healthcare benefit plan details, eligible beneficiary benefits, adjudication, and pricing of claims
• Lead resolution of any queries / issues / concerns raised related to provider’s healthcare plans / benefit offerings during the configuration process
• Assist in identifying and setting up training mechanisms for internal and external staff to provide appropriate knowledge and guidance for efficient product configuration process
• Work in synergy with specialists to routinely test and identify IT requirements in configuration systems to avoid any bugs and hindrances
• Evaluate the configuration process, systems, and tools to suggest improvement plans based on internal and external feedbacks, best practices, and optimum utilization process
• Extract and share assessment reports with seniors to highlight the effectiveness, achievements, and challenges of product configuration system and process

Policies, Processes, and Procedures

General Accountabilities

Seniority level

Employment type

Job function

Industries

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