MagnaCare is seeking experienced Enrollment and Eligibility Specialists to provide on-site, member-facing support for enrollment application processing, dependent verification, retiree transitions, and other eligibility-related functions. This role involves direct interaction with members to ensure accurate documentation, timely processing, and a clear understanding of benefit eligibility. The Specialists will deliver exceptional service while navigating complex enrollment scenarios and maintaining compliance with plan rules and privacy regulations.
Primary Responsibilities
Assist members in completing enrollment applications and ensure timely and accurate processing of enrollment requests.
Review, verify, and validate dependent eligibility documentation.
Process requests related to life events, including marriage, divorce, birth/adoption, QMSCO, QLE, and loss of coverage (COBRA) events.
Perform eligibility determinations for new enrollments, retirees, changes, reinstatements, disability credits, and terminations based on plan rules and documentation received.
Validate and apply disability credits by fund policy and ensure supporting documentation is complete and current.
Respond to member inquiries regarding eligibility status coverage effective dates and required documentation via phone, mail, or in-person communication.
Communicate clearly and compassionately with members, providing education and guidance on enrollment procedures, benefit options, and required next steps.
Maintain accurate and timely documentation of member interactions, enrollment actions, and correspondence in the system.
Collaborate with internal departments (such as Claims, Employer Services) to resolve discrepancies or clarify member status.
Handle escalated customer concerns and complaints.
Assist in customer service enrollment-eligibility related member-facing functions.
Essential Qualifications
Bachelor's degree in Accounting, Business, or Finance preferred, or high school diploma/GED with 5 to 7 years of relevant experience.
Minimum 1 year of experience in enrollment, eligibility, benefits administration, or customer service in a healthcare or insurance setting.
Working knowledge of enrollment policies, dependent eligibility requirements, COBRA, FMLA, QLE, and Medicare/Medicaid Benefits.
Experience with HIPAA regulations and handling of confidential health information.
Strong attention to detail, with the ability to process and verify large volumes of data.
Excellent interpersonal, written, and verbal communication skills; ability to explain complex benefits and eligibility information in simple terms.
Proficient in Microsoft Office (Word, Excel, Outlook) and comfortable using benefits administrative system.
Salesforce experience preferred.
Ability to manage multiple tasks, prioritize work, and meet deadlines in a fast-paced environment.
Strong problem-solving skills and ability to handle sensitive member situations with empathy and professionalism.
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.
