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Eligibility Processor III in Orange at Prospect Medical Systems

Date Posted: 12/27/2018

Job Snapshot

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Job Description

Eligibility Processor III

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Eligibility Processor is responsible for accurately adding/terminating members manually, as well as verifying eligibility information through the health plan website and taking incoming phone calls from provider offices.  This includes maintenance of Providers, Networks and Members.  

Job Responsibilities/Duties

  • Manually updating IDX with changes, additions, terminations to IDX.  Is accurate in reviewing the health plan websites for member information such as PCP, ID#, network affiliation, plan codes. Making sure health plan variances from the health plan files to IDX are <=1% variance or <= 50 member difference.  Is able to work eligibility tasks in its entirety, under minimal supervision.  Can undertake new tasks and decipher the process. Taking incoming phone calls from providers, and internal departments.

  • Ensures that operational duties will meet or exceed all relevant stated Service Level Agreements (SLA).  

  • Researches customer service questions and provides responses in a timely manner. 

  • Responds accurately and politely to all requests for eligibility verification, as well as telephone eligibility inquires. 

  • Documents member detail in the Customer Service Module (CSR).   Escalates errors to the appropriate departments.

  • ​Actively participate in supporting with special projects as well as serve as a resource for new staff.


Minimum Education: High School Diploma or equivalent, ability to operate PC based software programs.

Minimum Experience:  Four or more (4+ ) years working for HMO/IPA/MG/Dr. Office.     

Req. Certification/Licensure: None.                       

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

How to Apply

To apply for this role, or search our other openings, please visit and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

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