Health Plan Eligibility Associate

Adventist Health

Posted 2 months ago

Full Time

Roseville, California

In Person

Smart Summary

Responsibilities

The associate coordinates health plan eligibility and enrollment processes, including new enrollments, terminations, and member matching for claims. They also provide support to members and HR staff regarding medical, dental, and vision benefit inquiries.

Qualifications

You have a high school education or equivalent, with a preferred Associate's degree or a combination of education and related experience. You will be responsible for coordinating all aspects of health plan eligibility and enrollment for employees, including new enrollments, terminations, and changes, and will provide excellent service to members and HR employees.

Must Have Skills for ATS

medical claims

dental claims

vision claims

enrollments

terminations

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Coordinates all aspects of health plan eligibility and enrollment for the employee health plan. Performs clerical duties of eligibility management. Works on routine assignments within defined parameters, established guidelines and precedents.

Job Requirements:

Education and Work Experience:

  • High School Education/GED or equivalent: Preferred
  • Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred

Essential Functions:

  • Performs all aspects of health plan eligibility for employees, including, but not limited to: new enrollments, terminations and changes.
  • Processes address changes and return mail for the eligibility team.
  • Completes member matching for claims that came through unmatched.
  • Provides information as needed for questions related to medical, dental, vision claims based upon the benefit descriptions, claims payments and processing and plan provisions.
  • Provides excellent service to members and human resources employees via phone and email inquiries.
  • Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.


Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

Adventist Health

Adventist Health Central Coast (formerly Tenet Health Central Coast) is proud to serve the Central Coast of California. We offer care through two acute care hospitals, two imaging centers and an expansive primary and specialty care network.
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