MagnaCare is seeking experienced Enrollment & Eligibility Team Leaders to provide on-site support to the Enrollment & Eligibility Team as a Subject Matter Expert (SME). In this role, you will be responsible for ensuring timely, accurate processing of enrollment forms and eligibility-related documentation and verification, data entry, and employer services. The Team Leader must be detail-oriented, well-versed in eligibility rules and issue resolution, and able to serve as a key liaison among internal teams, employers, and vendors.
Primary Responsibilities
Oversee daily operations related to enrollment application processing, eligibility updates, dependent verification, retiree transitions, COBRA, and disability credit reviews.
Support Enrollment & Eligibility Specialists and Employer Services Representatives, assigning work, monitoring productivity, and providing guidance as needed.
Ensure timely and accurate processing of all enrollment and eligibility transactions in compliance with plan rules and regulatory requirements.
Review and ensure proper followup for incomplete and missing dependent eligibility documentation validations.
Monitor incoming documents and files from employers for accuracy and completeness, including hours files, demographic updates, and eligibility-triggering events.
Review and validate employer-submitted data for errors or inconsistencies; coordinate corrections and communicate with internal departments as needed.
Assist with the onboarding and ongoing support of employer groups, providing guidance on data submissions, portal usage, and required documentation.
Investigate and resolve escalated complex member or employer inquiries related to eligibility status, coverage updates, and enrollment outcomes.
Train team members, ensuring a high standard of service and accuracy across both enrollment and employer-facing functions.
Collaborate with management on process improvements, compliance initiatives, and system enhancements related to eligibility and employer data workflows.
Maintain detailed documentation and tracking of issues, followups, and resolutions for reporting and audit purposes.
Investigate and resolve complex member and employer inquiries regarding eligibility status, enrollment outcomes, and COBRA rights.
Ensure adherence to privacy and data protection standards (HIPAA) when handling member and employer information.
Essential Qualifications
Bachelor’s Degree preferred, or high school diploma/GED with 5 to 7 years in healthcare customer service–related roles.
Knowledge of managed care, labor, commercial carrier enrollment, and eligibility procedures, including hourly based eligibility and waiting periods.
Ability to handle sensitive PHI and financial data securely.
Knowledge of Medicare/Medicaid Benefits is a plus.
Strong attention to detail, analytical skills, and critical thinking for complex problem-solving.
A high level of professional written and verbal communication; interpersonal and organizational skills.
Adaptable to change and change management, capable of teamwork and independent work.
Proficiency in Microsoft Office (Word, Excel, and Outlook) and benefits administrative system.
Salesforce experience preferred.
Knowledge of eligibility files, transaction sets, HIPAA, COBRA, FMLA, LOAs, QLE, and PTO regulations preferred.
Excellent attendance, punctuality, and work performance record are required.
Must be a team player that can also work independently.
Bilingual Spanish required.
At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect, and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.
Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.
