Eligibility Specialist

Overview

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

Responsibilities

 

Ready To Own the Data Integrity That Keeps Member Eligibility Accurate Across a Complex Benefits Platform?

 

Why This Role Matters

Eligibility errors don't stay contained — they ripple into claims, coverage gaps, and client escalations. This role is responsible for validating, maintaining, and troubleshooting the eligibility and enrollment data that underpins benefits administration for our clients. The work is technical, detail-intensive, and directly tied to whether members have access to the coverage they're entitled to.

 

What You'll Actually Do

Analyze and validate eligibility files: Review raw data and flat files, run pre-load analysis to verify accuracy, and identify data issues before they reach downstream systems.

Standardize and transform data: Combine raw information from diverse sources into consistent, readable formats — including 834 file layouts — and submit eligibility and coverage data to downstream vendors.

Run quarterly and monthly censuses: Execute quarterly audits to catch invalid E13 spouse pends, overage dependents, invalid departments, rating structure and billing tier mismatches, ID card format errors, and life volume discrepancies. Run monthly per-client censuses on cut-off dates to validate certs and departments.

Build and improve eligibility processes: Assist in designing, programming, testing, and standardizing procedures for eligibility file processing and data management.

Communicate with clients and vendors: Coordinate directly with external vendors and clients on eligibility data questions, file issues, and resolution timelines.

 

 

Qualifications

What You Bring to Our Team

Education & Experience

• High school diploma or equivalent required
• Some post-secondary education preferred
• 1–2 years of experience with Eldorado (HealthPac), QikLink, or GAIS systems preferred

Technical Skills

• Strong proficiency in Excel for data analysis and eligibility file review
• Ability to manage and interpret raw data including 834 file layouts preferred
• Basic SQL skills preferred
• Familiarity with FTP file transfer protocols preferred
• Minimum 30 WPM typing with accuracy
• Strong general computer and internet proficiency

 

 

Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.

 

Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View all legitimate openings at personifyhealth.com/careers.