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Eligibility Clerk (West Hollywood)

compensation: $18/hr
employment type: full-time

Reports to: Assistant Manager, Eligibility


This position interfaces with department management, department staff and other Plans’ staff including the Audit, Contributions, Accounting and Operations Departments. Phone contact with participants, participants’ representatives and production companies.

This is a 3-4 month long temporary assignment.


• Answer eligibility calls from participants and participants’ representatives.
• Assist with open enrollment process.
• Adjust participant records: add/delete dependents; reinstatements; terminations; promote dependents etc.
• Coordinate with providers to update participants’ and dependents’ coverage.
• Process and set up coverage for domestic partners, divorced and surviving spouses.
• Set-up and coordinate coverage for surviving spouse of deceased participants.
• Monitor Delta Dental Discrepancy report and resolve issues.
• Monitor and follow-up Affidavit of Surviving Spouse.
• Assist any “walk-in” participants with any eligibility problems, adhere to their needs in regards to coverage and receive payments if necessary.
• Compose correspondence in relation to eligibility issues regarding required documents such as second documentation for marriage, marriage and birth certificates
• Monitor Domestic Partners’ plan coverage changes and coordinate with Accounting Department regarding the change for tax liability purposes.
• Prepare and reconcile Delta Care invoices for payment on a monthly basis.
• Set up COBRA coverage for dependents, surviving or divorce spouses.
• Review and approve /decline appeals due to late payment of premiums and late notice for adding dependents, change of coverage plan, COBRA qualifying events and election or notification expired for COBRA or during open enrollment.
• Assist department with various projects as necessary.
• Monitor and administer participants on DeltaCare.
• 90 Day Appeals.
• Regular, predictable, and reliable attendance is required.
• Ability to accept direction and developmental guidance from supervisor.
• Ability to work effectively with individuals at all levels.
• Perform other duties as required.
• Prepare daily correspondence/document for scanning.
• Perform other duties as assigned.


• Excellent verbal and written communication skills
• Strong analytical skills
• Good math skills
• Excellent organizational skills and attention to detail
• Ability to sort and file documents alphabetically and chronologically
• Proofread for accuracy in grammar and typing
• Proficient in Microsoft Word, intermediate Excel
• Ability to prioritize workload
• Ability to meet deadlines
• Ability to work independently with minimal supervision


Bachelor’s Degree with two - three years of customer service in group health insurance preferred. Extensive knowledge of Health Plan eligibility rules and systems, ERISA, COBRA, group insurance and Medicare principals. Considerable knowledge of basic math, 10-key by touch and, Microsoft Word and Excel

Benefits: Medical, Dental, Vision, 401k, Holidays, growth potential, and much more!

Equal Opportunity Employer considering qualified applicants in accordance with applicable state and federal laws, including those with criminal histories, in a manner consistent with the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.
  • Principals only. Recruiters, please don't contact this job poster.
  • do NOT contact us with unsolicited services or offers

post id: 7019443253



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