Eligibility Representative

Eligibility Representative I – Hybrid (Pittsburgh, PA)

A-Line Staffing is now hiring an Eligibility Representative I in Pittsburgh, PA. This Eligibility Representative I position would be working for a Fortune 500 healthcare company and has career growth potential. This would be a full-time position, 40 hours per week.

Eligibility Representative I Compensation

• Pay rate: $23.00 per hour
• Benefits available to full-time employees after 90 days
• 401(k) with company match available for eligible employees

Eligibility Representative I Highlights

• 6-month contract assignment
• Hybrid schedule based in Pittsburgh, PA
• Required to work onsite 2 days per week (Tuesday, Wednesday, or Thursday)
• Monday – Friday, 8:00 AM – 4:30 PM

Eligibility Representative I Responsibilities

• Process new enrollments, eligibility changes, and member cancellations
• Review, maintain, and update member eligibility records
• Respond to member and internal inquiries regarding eligibility and enrollment
• Resolve eligibility discrepancies and enrollment issues
• Complete redeterminations for participants due for renewal within 30-60 days
• Perform address updates, membership maintenance, and reconciliation activities
• Support special projects and operational initiatives as assigned
• Ensure compliance with state and federal healthcare regulations
• Maintain productivity, quality, and turnaround time expectations

Eligibility Representative I Requirements

• High School Diploma or equivalent required
• 1+ years of customer support experience, preferably within managed care or similar environment
• Knowledge of Medicaid, Medicare, and Dual Eligibility programs
• Ability to explain healthcare benefits and assist members with decision-making
• Experience handling high-volume outreach calls