Our client, a Union Benefit Administrator has an immediate need for an Eligibility Clerk. This person is responsible for managing and maintaining accurate records of union members' eligibility for health and welfare benefits. This role involves verifying eligibility for benefits, ensuring accurate enrollment, and processing changes or updates to coverage. The Eligibility Clerk will also work closely with union members, plan participants, and benefit providers to ensure compliance with union agreements, plan policies, and regulatory requirements.

Key Responsibilities:
Eligibility Verification & Enrollment:
Verify the eligibility of union members and their dependents for healthcare benefits according to the terms of union agreements and benefit plans.
Process new enrollments, terminations, and changes to coverage based on eligibility and member status updates.
Ensure all necessary documentation is submitted, completed, and accurate for enrollment, eligibility verification, or benefit changes.

Member Communication:
Communicate with union members and their families to provide information about their healthcare benefits, eligibility requirements, and enrollment deadlines.
Respond to inquiries from union members regarding eligibility status, benefit plan options, and coverage details.
Provide assistance with enrollment forms, beneficiary updates, and eligibility issues, and explain plan options clearly.

Benefit Plan Maintenance:
Maintain and update member eligibility records in the benefits management system or other relevant databases.
Work closely with other benefits administration staff to ensure the accuracy of records and ensure eligibility is properly tracked.
Collaborate with insurance carriers to verify and update member eligibility information and resolve discrepancies.

Compliance and Documentation:
Ensure all eligibility and enrollment activities are in compliance with union agreements, healthcare laws, and relevant regulations (e.g., COBRA, HIPAA, ERISA).
Maintain accurate and confidential records in accordance with privacy and confidentiality regulations.
Assist with the preparation of reports on eligibility status, plan participation, and benefit utilization for union leadership or insurance providers.

Claims and Discrepancy Resolution:
Assist union members with claims issues related to eligibility, including denied or rejected claims due to eligibility errors.
Investigate and resolve discrepancies or errors in eligibility data or coverage details by working with internal teams, insurance providers, or union representatives.

Reporting and Record Keeping:
Generate and maintain regular reports regarding member eligibility, enrollment, and coverage status for union leadership and external administrators.
Prepare reports and updates for auditors or regulatory agencies as required by union agreements or healthcare regulations.

Support for Benefit Administration Team:
Assist with various administrative tasks related to benefits administration, including processing documentation, tracking open enrollments, and maintaining updated eligibility information for union members.
Provide support during annual open enrollment periods, qualifying life events (QLEs), and other plan-related changes.

Qualifications:
Spanish language skills
High school diploma or equivalent required; some college coursework in healthcare administration, business, or a related field is preferred.

Apply now for immediate consideration.

EEO/AA Employer/Vet/Disabled.

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.