Eligibility Resume Sample

4.9
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Antoinette Bergstrom
66227 Zemlak River,  Chicago, IL
+1 (555) 888 4532

Work Experience


Eligibility Associate
10/2017 - PRESENT
Philadelphia, PA
  • Verifies packages are complete and in compliance with credit policies and
  • Process eligibility requests according to
  • National office staff members (e.g., vice presidents, legal counsel, managing directors) across various departments
  • Institutional administrators (e.g., directors of athletics, senior women administrators, faculty athletics representatives) and committee members
  • Conference office athletics administrators
  • Student-athletes and prospective student-athletes
  • Representatives from higher education associations and outside organizations
  • Experience in customer service setting
Eligibility Technician
07/2012 - 07/2017
San Francisco, CA
  • Maintains focus on achieving a positive outcome for constituents and Aetna
  • Effectively anticipates and responds to the culturally diverse needs of internal clients and external customers
  • Five to seven years’ experience including enrollment, premium billing, customer service and Medicaid regulatory experience
  • Experience in customer service setting
  • Manage eligibility team members. Develop employee’s skills, evaluate performance and provide feedback, and oversee resolution of employee relation issues. Oversee training, coaching and evaluation of new team members
  • Reacting quickly to changing priorities and adjusting to new assignments
  • Assisting team members in their research of Macy's historical data
Eligibility Assistant
06/2006 - 02/2012
San Francisco, CA
  • Computer or Other Skills
  • Experience in customer service setting
  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • General PC knowledge including Microsoft Office, Internet, and email; Technical expertise of ESI systems and
  • Navigates systems efficiently in all constituent interactions
  • Persistently reinforces communication of Aetna values and how they operationalize in practice
  • Identifies key links required between people and functions to achieve goals
  • Raise ideas and solutions to the appropriate level of the organization for sponsorship

Education


University of Minnesota Rochester
2001 - 2005
Bachelor's Degree in Social Work

Professional Skills


  • Strong computer skills, including working knowledge of Microsoft Windows and strong mouse and keyboarding skills
  • Demonstrated work experience organizing work and time, establishing priorities, working under pressure, and meeting deadlines
  • Experience providing customer relation skills both verbally and written
  • Excellent written and verbal communication and customer services skills
  • Demonstrated experience with training, leading or supervising individuals, groups or teams
  • Provide on-the-job training for new or existing team members. Mentor team to improve their understanding and skills
  • Demonstrated work experience interpreting and accurately applying detailed program rules, regulations, policies, and procedures

How to write Eligibility Resume

Eligibility role is responsible for training, java, integration, finance, credit, database, auditing, security, compensation, payroll.
To write great resume for eligibility job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Eligibility Resume

The section contact information is important in your eligibility resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Eligibility Resume

The section work experience is an essential part of your eligibility resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous eligibility responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular eligibility position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Eligibility resume experience can include:

  • Good communication, problem solving and organization skills, detail oriented
  • Typing skills ability
  • Mentor team to improve their understanding and skills
  • Analytical, problem-solving, and conceptual skills and ability to work with a technical, product, business and state client teams
  • Communicate effectively displaying courteous behavior both in person and on the telephone
  • Communicate effectively displaying courteous behavior both in person and on the telephone

Education on an Eligibility Resume

Make sure to make education a priority on your eligibility resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your eligibility experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Eligibility Resume

When listing skills on your eligibility resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical eligibility skills:

  • Knowledge and Abilities: Good typing skills
  • Excellent communication skills and the ability to communicate with candor
  • Strong Java Script skills
  • Knowledge of ESI products and services helpful; Experience training and coaching less experienced staff – patience
  • Solid experience of developing reporting solutions in government Health and Human Services eligibility programs
  • Customer service experience or 2+ years of experience in an office setting environment

List of Typical Experience For an Eligibility Resume

1

Experience For Eligibility Technician Resume

  • Work history demonstrating strong and effective oral and written communication skills
  • Demonstrated work experience directing and assessing the quality of the work of others in a positive manner while ensuring that performance standards are met
  • Demonstrated experience in assisting upset individuals, resolving issues and customer complaints in a satisfactory manner
  • Demonstrated experience for assisting upset individuals, resolving issues and customer complaints in a satisfactory manner
  • Demonstrated work experience providing direct supervision to staff with full supervisory authority
2

Experience For Eligibility Supervisor Resume

  • Prior experience working with eligibility, including enrollment/changes and term applications
  • Communicates effectively displaying courteous and professional behavior
  • Identifying any potential barriers and provide effective strategies for eligibility outcomes
  • Experience working with Adobe Acrobat Pro (extracting pages, highlighting, search, and working with applications within adobe)
  • Experience working with posting deposits/payments and reconciling with accounts receivable
  • Experience working with posting deposits / payments and reconciling with accounts receivable
  • Competency and experience in data entry and working in a technically-demanding environment
3

Experience For Enrollment Eligibility Representative Resume

  • Experience in customer service setting
  • Experience working with Word (basic documentation creation)
  • Experience in detecting eligibility discrepancies
  • Identify and prioritize work in order to meet deadlines including state requirements for timeliness
  • Experience of using Transact SQL (T-SQL) to write various database objects e.g. stored procedures, views, functions, triggers etc
  • Hands on experience with various reporting tool environments
4

Experience For Eligibility Associate Resume

  • Good understanding of HIPAA data Privacy and Security requirements and industry best practices
  • Identifies client data trends and acts as consultant to client to improve quality of data and the member experience
  • Experience in designing end to end data warehouse and solutions
  • Experience of designing ETL, OLAP Cubes and Schemas
  • Communicate effective both orally and in writing and provide a writing sample required
5

Experience For Eligibility Representative Resume

  • Experience with Medicaid and CHIP programs and policies through educational or entry-level business roles
  • Operate a variety of office equipment; dual monitors
  • Strong desire to help others
  • Meet department quality audits. Maintain and prioritize workload to ensure individual and departmental standards are consistently met or exceeded
  • Monitor Oncology Care Model patient enrollment and validate eligibility each month during the episode of care
  • Demonstrate an understanding for patient confidentiality to protect the patient and the clinic/corporation
6

Experience For Eligibility Officer Resume

  • Assisting member with documentation which involves traveling to member’s homes / Nursing home
  • Interviewing customers to obtain information, researching and applying complex policy and procedures,
  • Making eligibility determinations and benefit authorizations for clients applying for and/or receiving public assistance under rigid time frames accurately
  • Entering and retrieving information from a variety of sources including verbal, written, and electronic databases
  • Communicating information about policies, procedures, and program requirements to the general public and co-workers in person, in writing, and over the phone
  • Loading and support of all eligibility files for new and existing customers for UMR
  • Coaching and Motivating Employees
  • Providing education to Workers, Employer and Treating Medical Practioner in respect to rights and responsibilities
7

Experience For Benefits & Eligibility Representative Resume

  • Preparing new claims at time of registration and ensuring all relevant data and information is captured within the appropriate systems
  • Entering data from multiple data systems, and evaluating customer information to make correct benefit determinations
  • Communicating information about policies, procedures, and program requirements to the public, and to co-workers in person, in writing, and over the phone
  • Working in a high volume and fast paced local office
  • Obtaining authorizations or overrides as needed
  • Working with several types of member correspondence
  • Handling electronic eligibility files
  • Working knowledge of personal computer-based workstations and related business software suites
  • Ensuring compliance with the provision of the Safety Rehabilitation and Compensation Act 1988
8

Experience For Eligibility Business Analyst Resume

  • Communicating all decisions to the employer and the injured worker
  • Delivering a high level of service to achieve a positive, safe and sustained return to work as early as possible
  • Ensuring compliance with the provision of the Return to Work Act, 2014
  • Willing to work face to face with a wide range of members
  • Moving a large volume of paperwork through processes quickly,
  • Assisting in identifying and resolving payer trends and issues related to eligibility denials and rejections
  • Utilising appropriate referrals and investigation tools to expedite information gathering, ensuring accurate and timely determinations are achieved
9

Experience For Medicaid Eligibility Reviewer Resume

  • Communicating information about policies, procedures, and program requirements to the public and co-workers, in person, in writing, and over the phone
  • Researching errors by comparing enrollment error reports against system information along with clients and broker's records
  • Maintaining a high level of customer service when dealing with external stakeholders
  • Liaising with key internal stakeholders regarding difficult claim circumstances before determination
  • Working with Analytical and Researching techniques to trend or quantify projects
  • Evaluating and maintaining an eligibility application caseload
  • Sending correspondence to clients and brokers to gather information or provide updates for corrections
  • Providing administrative support to the Worker's Compensation claims management team (specifically, the Eligibility Team)
  • Determining the outcome of claims based on information at hand and in with legislation
10

Experience For Eligibility Data Analyst Resume

  • Verifying data in support of the medical assistance eligibility determination
  • Working in a technology based environment
  • Observe processing trends, offer suggestions for refresher training, and conduct training
  • Working with posting deposits / payments and reconciling with accounts receivable
  • Analyze reports against existing billing data and make appropriate changes to ensure billing accuracy
  • Provide on-the-job training for new or existing team members
  • Respond to applicants under the age of 65 living in the community requesting benefits and assist in the completion of eligibility form

List of Typical Skills For an Eligibility Resume

1

Skills For Eligibility Technician Resume

  • PC Skills, MS Word and MS Excel is required (Creating and editing spreadsheets in MS Excel and creating and editing letters in MS Word)
  • Communicate effectively with government and state stakeholders both orally and in writing
  • Build and lead small teams, managing resources, cost, and timelines effectively
  • Customer service experience or 1+ years of experience in an office setting environment
  • Enter and maintain case records effectively
  • CBMS navigation skills (required for the Q&A Team)
  • Effectively supervise
  • Data entry skills
2

Skills For Eligibility Supervisor Resume

  • Prior claim or eligibility experience
  • The ability to effectively lead and direct the activities of others
  • The ability to work effectively with a diverse group of employees and customers
  • A strong work ethic characterized by respect for others, professional conduct, and demonstrated leadership
  • Maintain composure, use diplomacy and tact, and effectively de-escalate crisis and hostile situations with various individuals
  • Billing Experience, specifically premium aging and reconciliation
  • Identifying any potential barriers and providing effective strategies for eligibility outcomes
  • Troubleshooting Experience (required for the Q&A Team)
3

Skills For Enrollment Eligibility Representative Resume

  • Experience working with Microsoft Excel (creating / updating spreadsheets) and Microsoft Word (creating / updating / formatting documents)
  • Experience working with Microsoft Excel (creating and updating spreadsheets) and Microsoft Word (creating, updating, and formatting documents)
  • Experience with Microsoft Excel including basic functions: creating, editing, and saving spreadsheets and graphs
  • Experience with Microsoft Access including basic functions: creating, editing and saving
  • Experience of developing reports using market leading reporting products and solutions
  • Experience in developing and managing quality and training initiatives
4

Skills For Eligibility Associate Resume

  • Experience developing and delivering training materials and newsletters for end-users
  • Strong reporting foundation and understanding of Dimensional Modeling
  • Experience Reading and Constructing flat files, EID files
  • Financial / Billing experience in a medical setting
  • Experience editing and creating spreadsheets in Microsoft Excel
  • Experience creating and editing presentations and professional documents in Microsoft PowerPoint
5

Skills For Eligibility Representative Resume

  • Experience working with the following systems: Eli Admin, CDB, ISet, UNET / TOPS, CBMS, Linx, Facets and Cosmos
  • Experience with Microsoft Visio (creating and managing diagrams)
  • Customer service experience analyzing and solving problems
  • Experience multi-tasking by toggling between multiple computer systems
  • Demonstrates knowledge of CPT coding and HCPC coding application
  • Develop effective working relationship with unit staff and provide guidance, technical assistance, and training as needed
  • Experience working with the following systems: Eli Admin, CDB, ISET, UNET / TOPS, CBMS, Linux, Facets and Cosmos
6

Skills For Eligibility Officer Resume

  • Experience managing public facing communications and public relations on large projects or for large organizations
  • Experience of designing and developing highly interactive reports and dashboards
  • Experience of managing data from multiple data sources including SQL, Oracle and/or any other relative structures
  • Previous experience using FileMaker (be able to access files in the program) and MS Access (be able to access information)
  • Enrollment experience using CPS is required
  • Experience in using Microsoft Outlook to manage emails and calendar
  • Experience with Microsoft Excel (document creation, editing, sort, save, store)
  • Experience with Microsoft Word (document creation, editing, sort, save, store)
  • Experience with Microsoft Outlook (email organization and calendar scheduling)
7

Skills For Benefits & Eligibility Representative Resume

  • Experience in customer service in a healthcare setting
  • Experience working with Microsoft Excel to create, sort, filter, & edit spreadsheets to summarize and analyze data
  • Experience working with Microsoft Word (document creation)
  • Experience working with the chronically ill, elderly, disabled, and or frail population
  • Experience with Microsoft PowerPoint (creating presentations)
  • Experience in working with state Medicaid and CHIP agencies
  • Experience with working on PERM eligibility
  • Manage multiple projects / assignments and competing priorities
  • Experience working in the healthcare industry (managed care organization) desired
8

Skills For Eligibility Business Analyst Resume

  • Experience working with the NICE application
  • Previous billing experience
  • Previous experience working with ERISA Compliant Benefit Funds
  • Billing and / or eligibility experience
  • Independently organize work and time, establish and prioritize competing tasks, work under pressure, and meet deadlines
9

Skills For Medicaid Eligibility Reviewer Resume

  • Experience organizing stakeholder forums
  • Experienced working in a call center environment on a daily basis
  • Windows (Advanced) – 10 years’ experience
  • Linux (Intermediate) – 10 years’ experience
  • Complete work with frequent interruptions and changing priorities
  • Demonstrated history of working well in a team environment with the ability to provide constructive feedback to staff on caseloads and to subordinate staff
  • A proven track record in delivering on customers’ needs/requirements
  • Proven track record in delivering on customers’ needs/requirements
10

Skills For Eligibility Data Analyst Resume

  • Professional experience working with the Colorado Benefits Management System (CBMS)
  • Demonstrated ability to communicate well, both verbally and in writing
  • Strong commitment to completing tasks accurately and efficiently
  • Billing and/or Eligibility experience
  • Billing and/or eligibility experience
  • Intermediate level experience using Microsoft Excel
  • Billing and / or Eligibility experience
  • Competency and experience in data entry and an ability to learn and use various computer platforms
  • Previous experience as a Supervisor, Team Lead, or SME

List of Typical Responsibilities For an Eligibility Resume

1

Responsibilities For Eligibility Technician Resume

  • Strong problem solving skills for identifying and resolving issues, and is proactive in addressing potential issues
  • Providing a positive service experience for our internal and external customers
  • Strong interest in developing training sessions or group learning tools
  • Experience utilizing data collection techniques and record keeping
  • Maintains good working knowledge of the contract tables and Case Rate plans
  • Skill in working with angry or upset individuals in a professional manner
2

Responsibilities For Eligibility Supervisor Resume

  • Experience with Windows PC applications including the ability to learn new and complex computer system applications
  • Resume showing prior work history
  • Experience in Customer Service, preferably in a Contact Center, human services, healthcare or service related field
  • Genuine service-orientated individual with a commitment to effective customer service and concern for others’ needs
  • Experience with Medicaid and CHIP programs and policies
  • Demonstrate proficiency in computer literacy, use of relevant computer applications such as MS Office, and use of other types of office technolology
  • Performing administrative functions by completing tasks such as completing standard letters, maintaining spreadsheets, photocopying and filing documents
3

Responsibilities For Enrollment Eligibility Representative Resume

  • Entering and retrieving information from a variety of sources including oral, written, and electronic data bases
  • Acting as Supervisor in Supervisor’s absence
  • Providing administrative support to the workers compensation claims management team
  • Performing inventory control of member and group transactions
  • Filing and file maintenance
  • Understanding of Medicaid and Medicare regulations
  • Storing applications and other case information appropriately
  • Sending accurate, timely notices
4

Responsibilities For Eligibility Associate Resume

  • Handling transfers from other entities (e.g., caseworker, system transfers)
  • Processing cases in a timely manner
  • Sending accurate and timely notices
  • Being responsible for calculation of Pre Injury Average Weekly Earnings (PIAWE)
  • Communicating information about policies, procedures, and program requirements to the general public in person, in writing, and over the phone
5

Responsibilities For Eligibility Representative Resume

  • Making sustainable, appropriate and quality initial liability determinations on claims
  • Communicating the initial decision rational to the Dispute Resolution Team to support the conciliation process
  • Working knowledge of Chase credit policy, procedures and bank regulations
  • Manage the monthly billing of the Oncology Care Model (OCM) patient and ensure the integrity of the billing or non-billing
  • Moderate repetitive arm, wrist, hand and finger motions making repetitive movements (e.g. key boarding, filing, data entry)
6

Responsibilities For Eligibility Officer Resume

  • Relational database for data querying, programming and creation of database objects for Eligibility, CTI and/or CRM domains
  • Passion and interest in Reporting, Dashboards, Reports, Data-modelling, Data warehouses, ETL Processes and Data Integration
  • Serves as a scribe during meetings, including kickoff calls, clarification questions reviews, writers’ calls, debrief review sessions, and any other important proposal meetings
  • Oversees functions associated with the review of supporting documentation submitted by consumers for the purpose of satisfying documentation requests
  • Ensure application is complete, legible and properly filled out by completing the following steps
7

Responsibilities For Benefits & Eligibility Representative Resume

  • Notifies coordinator or manager of problems arising from erroneous items, codes, or missing information
  • Act as a resource to customers and internal partners for troubleshooting application issues and open tickets with IT on resolving member and system errors
  • Assists management with overseeing and tracking inventory. Assists Management with work distribution to team members if necessary
  • Independent, self - starter who’s driven by doing new things and making an impact
  • A writing sample demonstrating your ability to communicate policy or procedures
8

Responsibilities For Eligibility Business Analyst Resume

  • Current typing test (within the past 90 days). Typing tests are given at any Alaska Job Center location
  • Knowledge of medical coding, preferable oncology coding
  • Revise IES Program financial documents as directed based on actual spending, risks, changes to cost allocation, funding approvals, and other factors
  • Develop and deliver online and print content for training and newsletters on upcoming releases of functionality for IES end-users
  • Develop and deliver online and print content for training and distribution on upcoming functionality releases for IES end-users
  • Establish and maintain positive and energizing IES message and image reflecting project business objectives
  • Support monthly COBRA participant invoicing process
9

Responsibilities For Medicaid Eligibility Reviewer Resume

  • Maintain working knowledge of all applicable federal COBRA regulations
  • Assist COBRA Department with project initiatives such as filing, open enrollment fulfillment, and daily mail coordination
  • Field questions from Patient Advocacy Liaison Team regarding work responsibilities and concerns
  • Maintain confidentiality regarding patient’s health records and the company’s business practices
  • Enforce disciplinary action as warranted concerning any employee misconduct
  • Participate in workload balancing and represents supervisor when absent
  • Learn, interpret, and apply complex programs accurately, fairly, and in a timely manner according to strict guidelines
  • Verify the identity of the applicant; check applicant's identity by viewing Driver’s License or Florida ID card
  • Check for complete and legible mailing address on application
10

Responsibilities For Eligibility Data Analyst Resume

  • Conduct fact-finding interview to identify needs
  • Respond to various types of member eligibility or group inquiries, including verify enrollment status, from internal and external customers
  • Handles outgoing eligibility files for ID card, pharmacy vendors and many other vendors
  • Negotiates pricing as necessary and authorizes patient services
  • Liaise with key internal stakeholders regarding difficult claim circumstances before determination
  • Reviews information provided by clients and assist clients in accessing computer applications
  • Assist recipients by answering questions about 1095-B form(s)
  • Perform moderately-complex tasks following established procedures and practices

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