Eligibility Representative

Role Overview

You will be the operational link between members, clients, and the systems that determine who gets access to healthcare coverage. Every day, you will process enrollment and status changes, verify member data, and field eligibility questions from customers and internal teams, making sure that nothing stands between a person and their benefits. Your careful handling of records and your ability to resolve mismatches quickly will directly affect whether members experience a smooth, timely entry into care or face frustrating delays.

Key Responsibilities

• Maintain up-to-date eligibility records across all relevant platforms, including processing new member setups, plan changes, renewals, and coverage terminations within agreed turnaround times.
• Act as the first point of contact for external clients, members, vendors, and colleagues who need help understanding or correcting eligibility status.
• Investigate and correct data mismatches, system errors, and file-feed failures that could otherwise result in denied claims or disrupted access to services.
• Run periodic data checks and produce accuracy reports that help the wider team spot issues before they affect the member experience.
• Coordinate closely with client account managers, operations peers, and technical support staff to resolve complex eligibility cases without losing sight of the member's needs.
• Support the rollout of new clients, benefit plan designs, and system enhancements by testing eligibility workflows and preparing relevant documentation.
• Identify recurring bottlenecks in processing or data handling, then propose practical improvements to reduce manual effort and error rates.
• Protect sensitive member information by applying data privacy standards and confidentiality protocols to every transaction and communication.

Requirements & Qualifications

• Diploma or bachelor's degree preferred, though equivalent professional experience in a related operational role is acceptable.
• Full professional proficiency in both English and French, with clear written communication for emails and confident verbal communication for phone support.
• Demonstrated experience using customer databases, spreadsheet tools, and case tracking systems to record, update, and retrieve information accurately.
• Strong attention to detail, especially when reconciling large volumes of data or following strict eligibility guidelines.
• Ability to prioritize multiple requests in a fast-paced environment while keeping service levels and deadlines in view.
• Practical problem-solving skills, including the ability to diagnose why a member record is incorrect and determine the right correction path.
• Comfort with Microsoft Outlook and Excel on a daily basis, including sorting, filtering, and basic data review functions.
• A natural service mindset: you listen carefully, explain clearly, and take ownership of issues until they are truly resolved.
• Previous exposure to healthcare administration, insurance operations, or eligibility management is a plus, as is familiarity with automated data feeds and direct-connect enrollment files.

What We Offer / Why Join

You will become part of a global, multicultural team where collaboration is not just encouraged but essential to getting the work done. The role gives you the chance to see the direct human impact of accurate administration: every clean enrollment and every corrected error means a member can move forward with their healthcare without barriers. In this environment, you can grow your expertise in a specialized area of health operations while contributing to a culture focused on service quality and continuous improvement.