Benefit Eligibility Auditor

About This Role

Perform routine benefit plan eligibility audits for a health benefits pool, including member and dependent eligibility, qualifying life events, and waiver requests. Review eligibility rules and documentation to ensure individuals are entitled to participate in the plan.

Responsibilities

• Take ownership of inquiries and drive them to efficient and effective resolutions
• Act as the liaison between TXHB and customer(s) for all inquiries
• Document and manage all communication and documentation received
• Participate in and lead AAW related meetings as needed
• Apply eligibility and general benefits knowledge to inquiries
• Perform routine audits of Qualifying Life Events to ensure requested changes are consistent with changes made
• Perform routine audits on waiver reasons to ensure appropriate documentation is obtained
• Perform routine dependent eligibility documentation audits
• Perform audits and reconcile eligibility data with internal and external vendors to ensure accuracy for benefit access
• Educate members on eligibility requirements, actively at work requirements, audit processes, and related matters

Requirements

• Strong attention to detail
• Solid understanding of eligibility and Section 125 rules and regulations
• Ability to diffuse difficult or challenging conversations
• Advanced Excel skills
• Strong verbal and written communication skills
• Advanced knowledge of benefit terminology and TXHB benefits design
• Expert knowledge of eligibility requirements including Section 125 rules
• Knowledge of COBRA, FMLA, and leave administration practices
• Strong knowledge of MS Office and billing and enrollment software

Qualifications

• Graduation from an accredited four-year college or university with major coursework in business administration, insurance, or a related field
• Two or more years of experience interpreting and applying Section 125 rules and analyzing benefits data

Skills

* Required skills