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Eligibility Operations Advisor I - Remote (US)

Date:  May 25, 2023

Any city, LA, US, 99999

Req ID:  18565

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 




We are seeking a talented individual for an Eligibility Operations Advisor I who is responsible for verifying, documenting, and coordinating information needed to process applications and other Eligibility Operations assignments.  Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation, and timely processing.




Your role in our mission


  • Provide enrollment assistance and HIPP/Premium Assistance program information over the phone to Medicaid eligible recipients and their family members.
  • Verify, document and investigate the presence of health care coverage for Medicaid recipients and their families.
  • Assist in the identification of members that may qualify for the HIPP/Premium Assistance program.
  • Complete periodic reports.
  • Customer service to include high volume of phone work answering questions and other inquiries regarding the HIPP/Premium Assistance program.
  • Data entry to include accurate and timely entry of information.
  • Obtain and/or verify all items related to eligibility and enrollment into the HIPP/Premium Assistance program.
  • Complete maintenance of active cases during open enrollment and premium review for check processing to assist with maintaining the revenue and program growth.




What we're looking for


  • Min. 2 years of experience in the insurance industry, health care, or government-sponsored health insurance including customer service and medical billing knowledge or similar math-related experience Required.
  • Min. 3 years experience working on the phone making inquiries (outbound) and answering calls (inbound) Required.
  • Ability to work with Microsoft Word and Excel and navigate the internet skillfully.   
  • MassHealth Experience Preferred
  • Customer Service Experience Preferred
  • Human Resources or Health Insurance Experience preferred




What you should expect in this role


  • This is a work-from-home position; however, this is only open to those within the 48 contiguous states.
  • Full-time (40 hours per week)
  • All needed equipment company provided
  • You must have internet access and a quiet work area
  • Benefits start on first day of employment















The pay range for this position is $15.00 - $18.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.


We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.


Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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