Eligibility Specialist – Healthcare
Location: Fort Worth, TX
Job Type: Contract
Company: IDR
Category: All Other
Job Description Apply Now
The role of an Eligibility Specialist – Healthcare is essential within the health plan operations sector, particularly for organizations focused on delivering accurate and timely member services. In this capacity, the Eligibility Specialist – Healthcare is responsible for the comprehensive management of member eligibility records, the resolution of complex enrollment inquiries, and the facilitation of interdepartmental collaboration to ensure ongoing compliance and the highest standards of service quality. This full-time opportunity offers professionals a chance to utilize their attention to detail and analytical abilities within a dynamic, fast-paced healthcare environment.
As an Eligibility Specialist – Healthcare, you will play a crucial role in supporting operational excellence by meticulously verifying member coverage status, investigating discrepancies, and executing enrollment updates. This position requires a strong understanding of healthcare administration, a commitment to accuracy, and the ability to communicate effectively across a variety of platforms. The successful candidate will bring a robust background in healthcare eligibility or enrollment and a drive to maintain the highest standards of compliance and customer service.
In this role, you will:
- Research and resolve member eligibility and enrollment inquiries using phone, email, and internal communication systems.
- Review enrollment histories, eligibility files, and supporting documentation to confirm member coverage and resolve discrepancies.
- Process enrollment changes, corrections, and retroactive updates to ensure records remain up-to-date and accurate.
- Maintain thorough documentation of findings and actions taken to support audit readiness and regulatory compliance.
- Generate membership and eligibility reports, collaborating with internal teams to identify and resolve systemic issues affecting member records.
- Participate in ongoing training and process improvement initiatives to enhance the effectiveness of health plan operations.
Organizations value the expertise of an Eligibility Specialist – Healthcare, as they play a pivotal role in ensuring that members receive the correct coverage and that operational processes align with industry regulations. This position is ideal for individuals passionate about supporting the healthcare system through administrative excellence and who thrive in a collaborative, results-oriented setting.
Working as an Eligibility Specialist – Healthcare in Fort Worth, TX, offers the advantage of being part of a vibrant and growing healthcare sector. The area is known for its commitment to healthcare innovation and its supportive professional community, providing ample opportunities for career growth and professional development.
As part of a dynamic team, you will have access to a comprehensive suite of benefits designed to support your well-being and professional advancement. The organization’s long-standing reputation in the industry, combined with its employee-focused culture and commitment to diversity and inclusion, makes this an exceptional opportunity for experienced professionals in healthcare administration.
Eligibility Specialist – Healthcare Summary- Full-time position focused on ensuring member eligibility and accurate enrollment within healthcare operations.
- Key liaison between members, internal teams, and regulatory compliance processes.
- Supports operational accuracy, audit readiness, and continuous process improvement.
- Research and address inquiries regarding member eligibility and enrollment via multiple communication channels.
- Analyze enrollment records and eligibility files to verify member coverage status.
- Implement enrollment changes, corrections, and retroactive updates with precision.
- Document findings and actions to maintain audit trails and compliance standards.
- Produce reports on membership and eligibility trends for internal review and action.
- Collaborate with cross-functional teams to resolve systemic eligibility issues and improve processes.
- Remain current with healthcare regulations and participate in ongoing training sessions.
- Competitive compensation package commensurate with experience and industry standards.
- Comprehensive health benefits including medical, vision, dental, and life insurance.
- Access to an Employee Stock Ownership Program and dedicated engagement management.
- Opportunities to work within an award-winning organization recognized for excellence in staffing and client service.
- Minimum of 1-3 years of experience in healthcare enrollment, eligibility, or a related administrative role.
- Demonstrated ability to research and resolve health insurance eligibility issues.
- Exceptional attention to detail, organizational, and analytical skills.
- Proficiency in interpreting healthcare eligibility data and accurately updating records.
- Strong written and verbal communication abilities.
- Detail-oriented and organized with a commitment to compliance and service quality.
- Comfortable navigating healthcare administrative systems and multi-channel communication tools.
- Skilled at collaborating with internal teams to resolve complex eligibility issues.
- Adaptable to a fast-paced and dynamic work environment.
- Proactive in identifying areas for process improvement and operational excellence.
- The organization is committed to diversity, inclusion, and equal employment opportunity.
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
- The company adheres strictly to governmental record-keeping and civil rights regulations, ensuring confidentiality and voluntary participation in self-identification surveys.
- This is an excellent opportunity to join a reputable healthcare organization offering growth, support, and a strong commitment to employee success.
If you are ready to advance your career as an Eligibility Specialist – Healthcare, click the application button to take the next step in joining a leading healthcare organization.