Eligibility Representative
Naperville, IL
Eligibility Representative
100% remote, Monday-Friday during standard business hours, for 3 months with possible extension or conversion. Processes Medicare eligibility and enrollment data; requires Medicare Advantage knowledge, Excel, strong attention to detail, and a background check with drug screening.
Eligibility Representative
Location: 100% Remote
Contract duration: 3 months (opportunity for extension or conversion to FTE, depending on performance, attendance, and business needs).
Schedule: Monday – Friday, Standard business hours
Target Start Date: ASAP, pending completion of new hire onboarding
Pay Rate: $18/hr (Paid weekly)
Position Overview
The Eligibility Representative is responsible for performing analytical and administrative functions to support Medicare enrollment and eligibility processes. This position is data-driven and transactional in nature, with a strong focus on accuracy, compliance, and Medicare requirements rather than customer-facing activities.
Key Responsibilities
Important Role Clarification
Required Qualifications
Preferred Qualifications
#TMHC
Location: 100% Remote
Contract duration: 3 months (opportunity for extension or conversion to FTE, depending on performance, attendance, and business needs).
Schedule: Monday – Friday, Standard business hours
Target Start Date: ASAP, pending completion of new hire onboarding
Pay Rate: $18/hr (Paid weekly)
Position Overview
The Eligibility Representative is responsible for performing analytical and administrative functions to support Medicare enrollment and eligibility processes. This position is data-driven and transactional in nature, with a strong focus on accuracy, compliance, and Medicare requirements rather than customer-facing activities.
Key Responsibilities
- Process and maintain eligibility and enrollment transactions, including updates, corrections, and reconciliations of member data
- Review and analyze eligibility reports to identify discrepancies and ensure accurate resolution
- Implement and maintain data across automated systems, direct connections, and manual workflows
- Verify eligibility and ensure compliance with Medicare guidelines and regulatory requirements
- Partner with internal teams (e.g., systems, operations) to investigate and resolve data or processing errors
- Perform detailed data entry and validation tasks with a high level of accuracy and timeliness
- Monitor transaction outputs to ensure completeness and adherence to established standards
Important Role Clarification
- This role is not primarily customer service-based and does not focus on call handling. This role is customer focus , not customer service . We don't speak to members at all really.
- Responsibilities center on processing enrollment transactions and eligibility data, which require strong analytical skills and attention to detail
- Verifying eligibility and processing enrollment applications/transactions are distinct functions, with this role emphasizing transaction processing and data integrity
Required Qualifications
- Working knowledge of Medicare Advantage enrollment and eligibility (Part A, Part B, and Part C)
- Strong analytical and problem-solving skills with a data-focused mindset
- High attention to detail and ability to manage large volumes of transactional work
- Proficiency in Microsoft Office Suite (especially Excel)
- Ability to work independently with minimal supervision
- Strong written communication skills for internal collaboration
Preferred Qualifications
- 1+ year of experience in healthcare insurance
- 1+ year of experience in enrollment and eligibility processing (Medicare Advantage preferred)
- Prior experience with data entry, enrollment systems, and transaction processing
#TMHC