Member Eligibility Specialist

We are looking for a Member Eligibility Analyst to support operational oversight and process optimization efforts for a health insurance organization. This contract position focuses on strengthening monitoring activities, improving workflow performance, and helping teams move toward more efficient paperless operations. The role partners with stakeholders across the business to evaluate issues, interpret data, and recommend practical process enhancements that improve quality and consistency.

Responsibilities:

• Review and interpret member eligibility information to ensure accurate identification and matching of member records.
• Analyze data across multiple systems to validate member information, identify discrepancies, and resolve matching issues.
• Research and investigate eligibility discrepancies using critical thinking and problem-solving skills.
• Apply knowledge of member eligibility concepts, policies, and processes to make informed decisions.
• Navigate multiple systems and data sources to gather information and determine appropriate next steps.
• Independently assess complex or unfamiliar situations that may not have clearly documented procedures or standard operating procedures (SOPs).
• Adapt to changing priorities and processes while maintaining accuracy and productivity in a fast-paced environment.
• Identify trends, inconsistencies, and potential data issues and recommend appropriate resolutions.
• Exercise sound judgment and decision-making when handling ambiguous situations with limited guidance.
• Previous experience in the healthcare industry (healthcare administration, health insurance, claims, billing, enrollment, or eligibility).
• Understanding of healthcare member eligibility concepts and processes.
• Strong analytical and critical-thinking skills with the ability to review data, identify discrepancies, and determine appropriate resolutions.
• Experience navigating multiple systems and reviewing member information for accuracy.
• Strong problem-solving skills and the ability to work independently with minimal supervision.
• Ability to navigate ambiguity and make sound decisions when processes are not clearly documented.
• Excellent attention to detail and organizational skills.
• Ability to adapt to changing priorities and work effectively in a fast-paced environment.