Eligibility Specialist (Healthtech)

TL;DR

Eligibility Specialist (Healthtech): Validating and maintaining member eligibility and enrollment data for a personalized health platform with an accent on data integrity and 834 file layouts. Focus on running audits, transforming raw data, and resolving discrepancies to ensure seamless coverage access.

Location: Tuzla, Bosnia and Herzegovina

Company

hirify.global has created a personalized health platform that integrates health plan administration, holistic wellbeing solutions, and comprehensive care navigation.

What you will do

• Analyze and validate eligibility files, running pre-load analysis to identify and resolve data issues.
• Standardize and transform raw data from diverse sources into consistent formats, specifically utilizing 834 file layouts.
• Execute quarterly and monthly censuses to audit spouse pends, overage dependents, billing tiers, and life volume discrepancies.
• Assist in designing, programming, and testing standardized procedures for eligibility file processing.
• Coordinate directly with external vendors and clients regarding eligibility data questions and resolution timelines.

Requirements

• High school diploma or equivalent (required).
• 1–2 years of experience with Eldorado (HealthPac), QikLink, or GAIS systems (preferred).
• 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 and familiarity with FTP file transfer protocols (preferred).
• Minimum 30 WPM typing speed with high accuracy.

Culture & Benefits

• Equal opportunity employer committed to diversity, equity, inclusion, and belonging.
• Work environment where differences are celebrated and employees from all backgrounds are empowered.