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Job Details

Eligibility Research Representative

Company name
Total Package Professional Services

, CA

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Statement of Overall Purpose or Job Objective

The primary function of this position is to research and resolve eligibility verification requests in an appropriate and timely manner.

*Researches and resolves member eligibility requests.

Eligibility Research Verification:

• Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected.

• Verifies member eligibility from eligibility file, communications log, and health plan websites or by calling the health plan directly when all other resources are exhausted.

• Inputs and saves verified member's information into the communications log and/or member maintenance.

• Ensures the highest quality of customer service by maintaining a professional and courteous manner.

Customer Service Research:

• Processes research same day to ensure 24 hour tu

around time is met.

• Makes follow up calls same day to providers and members to give results of research.

• Transfers providers to provider queue if question is not related to eligibility.

• Transfers members to member queue if caller has detailed questions or wishes to file a complaint.

• Updates member and group records as needed.


• High School diploma or equivalent.

• Minimum one year of experience with 10 key, typing, and computer skills. 8,000-10,000 key strokes per hour required.

• Excellent customer service skills, with experience making outbound calls and meeting expectations for productivity and accuracy required.

• Experience with claims processing or eligibility verification preferred.

Company info

Total Package Professional Services

Company Profile

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