Eligibility Technical Specialist

Los Angeles, CA

Employment Type: Direct Hire Category: Professional Services Job Number: LA-SC-EligSpec Pay Rate: $50.000.00 - $52,000.00 per year

Job Description

The Eligibility Technical Specialist is in a core business unit that serves our members and their families by providing important information and support with Health benefit enrollment and organization’s Health eligibility requirements. This includes but is not limited to; enrollment assistance, address changes, explaining earnings requirements, basic plan benefits, COBRA, HIPAA and related aspects of the Affordable Care Act. The specialist works closely with the department’s leadership to assist in the day-to-day functions of the department such as administrative tasks, filing, and answering phone calls and emails. In addition, the Specialist will collaborate with the IT Help Desk and health care partners to detect and resolve system and eligibility data issues. The Specialist is also responsible for providing excellent customer service to every customer. This includes internal Fund staff as well external customers such as Health Care Partners, business managers, agents, our members/participants, and the Union.


  • Logs into departments phone queue daily to take phone calls
  • Cross-trained to process the departments work load including but not limited to: new eligibility, loss of coverage etc., dependent coverage, pharmacy issues, COBRA Administration, Monthly/Quarterly/Annual processes and more
  • Maintains lists of any Participants with coverage exception issues that must be manually updated (weekly/monthly) and performs necessary data entry
  • Provides training and instruction for system overrides and “work-arounds” to team members as necessary
  • Coordinates with the Eligibility Team, the I.T.’s B.A. team, and all vendors (i.e., Anthem Blue Cross, Express Scripts, Delta Dental, Davis Vision and the UCLA/Motion Picture Fund) to identify and resolve eligibility data issues discovered in our system, data file transmissions and vendor discrepancy reports
  • Performs system testing (as needed) of all proposed resolutions to Help Desk Tickets and reports results to the department Assistant Manager and/or Manager
  • Performs manual calculation of Qualified Certified Retiree Health Quarters for all requests received from the Pension Department
  • Assists the Sr. Eligibility Technical Specialist in gathering all necessary data (electronic and manual) for monthly and quarterly performance reports to COO and CEO

Job Requirements


  • Four-year college degree preferred or equivalent work experience
  • 4-5 years’ customer service/call center queue environment experience
  • Customer/Client focused
  • Use of strong listening/communication skills to strengthen relationships and create the right impressions; Strong interpersonal skills
  • Ability to accurately interpret written and oral communications
  • Proficient with Microsoft products, including Word and Excel
  • Independent worker with the ability to work in a team environment
  • Highly developed sense of integrity and commitment to excellence and effectively interact with other departments and outside contact
  • Capable of defining problems, collecting data, establish facts and draw valid conclusions
  • Self-sufficient with excellent time management skills
  • Sense of urgency, deadline driven
  • Ability to deal effectively with stressful situations
  • Proven problem solving and sharp analytical skills
  • Business analytics experience
  • Strong organization and time management skills

Additional Information

Equal Opportunity Employer considering qualified candidates in accordance with state and federal laws, including those with criminal histories, in a manner consistent with the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.

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