Enrollment and Eligibility Team Lead
Chapel Hill, NC
Full Time
Experienced
About The Role
Brighton Health Plan Solutions (BHPS) seeks an experienced Enrollment and Eligibility Team Lead for our hybrid contact center and processing unit. The Enrollment and Eligibility Team’s (EET) mission is to create, audit, process and update the member and eligible dependents’ profile(s) keeping their health, well-being, and continuity of care at the forefront of our day-to-day operations. And we partner and collaborate with key stakeholders (the client, employer partners, Customer Service, IT, Finance, Carriers, Vendors, and more) to do so successfully and timely.
The Enrollment and Eligibility Team Lead plays a critical role in our Enrollment and Eligibility/Employer Services Department. Our team is responsible for completing the day-to-day functions of enrollment and eligibility processing by ensuring that participants are accurately enrolled in the correct health plan, supporting Eligibility Call Centers, as managing the daily communication with participants. The E&E Team Lead must be detail orientated to ensure that all forms and documents received are processed efficiently and according to procedure. They are also responsible for ensuring that all eligibility and enrollment functions are completed in a timely and accurate manner. The Team Lead supports the EET Supervisors, EE Specialists, clients, employer partners, and members via phone and email support.
The Team Lead should be knowledgeable in eligibility, data entry, and member query resolution. They will engage with various stakeholders for investigations and serve as a liaison with our West Coast clients.
Primary Responsibilities
Essential Qualifications
Brighton Health Plan Solutions (BHPS) seeks an experienced Enrollment and Eligibility Team Lead for our hybrid contact center and processing unit. The Enrollment and Eligibility Team’s (EET) mission is to create, audit, process and update the member and eligible dependents’ profile(s) keeping their health, well-being, and continuity of care at the forefront of our day-to-day operations. And we partner and collaborate with key stakeholders (the client, employer partners, Customer Service, IT, Finance, Carriers, Vendors, and more) to do so successfully and timely.
The Enrollment and Eligibility Team Lead plays a critical role in our Enrollment and Eligibility/Employer Services Department. Our team is responsible for completing the day-to-day functions of enrollment and eligibility processing by ensuring that participants are accurately enrolled in the correct health plan, supporting Eligibility Call Centers, as managing the daily communication with participants. The E&E Team Lead must be detail orientated to ensure that all forms and documents received are processed efficiently and according to procedure. They are also responsible for ensuring that all eligibility and enrollment functions are completed in a timely and accurate manner. The Team Lead supports the EET Supervisors, EE Specialists, clients, employer partners, and members via phone and email support.
The Team Lead should be knowledgeable in eligibility, data entry, and member query resolution. They will engage with various stakeholders for investigations and serve as a liaison with our West Coast clients.
Primary Responsibilities
- Data Management: Create, audit, process and update the member and eligible dependents’ profile(s) into the enrollment database & update the database with changes.
- Data Analytics: Reconciling eligibility discrepancies, analyzing transactional data & submitting retroactive eligibility changes.
- Troubleshoot Enrollment and Eligibility related inquiries from the Clients, Employer Partners, Health Plan Carriers, the COBRA vendor, and Call Center Representatives, during peak seasons.
- Collaborate with EET Supervisor and Manager for reporting, compliance, trends, and improvement initiatives.
- Serve as a Subject Matter Expert (SME) in designated subtopics and benefits.
- Conduct team audits, quality assurance analysis, and support Management in trainings and meetings.
- Work directly with Client, Customer Service, Finance, and IT teams to resolve escalated enrollment issues.
- Contact Employers for delinquencies and communicate effectively with stakeholders.
- Participate in activities to enhance customer satisfaction and business performance.
- Solve unique problems through conceptual thinking, maintaining broad client knowledge.
- Foster a positive and collaborative work environment.
- Support projects and other departments as needed.
Essential Qualifications
- Flexibility to work alternate schedules/hours based on the business’s need. Our clients are on the West Coast. As such, the department’s hours are 10am-9pmEST (7am-6pm PST).
- Preferred: Bachelor’s Degree; Alternatively, High School diploma/GED with 5-7 years in healthcare customer service-related roles.
- Knowledge of with managed care, labor, and commercial carrier enrollment, eligibility procedures, including hourly-based eligibility and waiting periods.
- Proficiency in Windows 365 applications, including Word, Excel, Teams
- Ability to handle sensitive PHI and financial data securely.
- Knowledge of Salesforce is a plus.
- Knowledge of Medicare/Medicaid Benefits is a plus.
- Strong attention to detail, analytical skills, and critical thinking for complex problem-solving
- Must maintain a high-level of professionalism communication (written and verbal), interpersonal, and organizational skills at all times.
- Adaptable to change and change management, capable of both teamwork and independent work.
- Knowledge of eligibility files, transaction sets, HIPAA, COBRA, FMLA, LOAs, QLE, PTO regulations preferred.
- Excellent attendance, punctuality and work performance record required.
- Must be a team player that is able to work independently as well.
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