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Position: Health Insurance Eligibility & Enrollment Specialist

Work setup: Night shift | Hybrid

Location: Ortigas, Pasig City

Why join MicroSourcing

You'll Have:

Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonuses
A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
Career Growth: Take advantage of opportunities for continuous learning and career advancement.
Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.

Key Responsibilities

The Health Insurance Eligibility & Enrollment Specialist is a role embedded within Sales Operations team, responsible for managing the full eligibility lifecycle for small group insurance accounts — from initial account and member setup through ongoing maintenance, updates, and day-to-day eligibility requests. This position owns eligibility administration end to end rather than supporting another team member's queue.

The Eligibility Specialist's primary function is to independently manage enrollment queue volume, process eligibility documentation, and maintain accurate member and account records across Employee Navigator, DataSource, and related systems. A secondary function of this role is to provide seasonal quoting support to the administrative team during peak Q4/OEP periods, assisting the primary quoting staff with overflow requests.

The ideal candidate is highly organized, detail-oriented, and experienced in insurance operations, eligibility administration, or benefits administration. This role operates under the direction of CBC's Sales Operations Manager and works collaboratively with the domestic sales and administrative teams on a daily basis.

Key Responsibilities

Eligibility Lifecycle Management (Primary Function)

Own the full eligibility lifecycle for assigned small group accounts — from initial account and member setup in Employee Navigator and DataSource through ongoing maintenance, changes, and terminations.
Set up new groups and members in Employee Navigator and DataSource at the point of enrollment, ensuring accurate plan assignments, effective dates, and contribution structures.
Update and maintain eligibility records in Employee Navigator on an ongoing basis, including member adds, terminations, dependent changes, and plan or tier changes.
Update and maintain eligibility records in DataSource in parallel with Employee Navigator, ensuring both systems remain consistent and current.
Respond to and resolve day-to-day eligibility requests from clients, carriers, and internal teams, including coverage verifications, effective date confirmations, and eligibility discrepancy inquiries.
Process qualifying life event (QLE) documentation and mid-year enrollment changes for existing small group clients across all systems of record.

Enrollment Queue Support

Process and work assigned enrollment queues in the contact center platform, covering small group form submissions and email-based enrollment channels.
Review, validate, and process incoming enrollment forms for small group accounts, ensuring all required fields, signatures, and supporting documents are complete and accurate.
Submit completed enrollment packages to the appropriate carriers within required processing deadlines.
Identify and flag incomplete, inconsistent, or non-compliant enrollment submissions and route to the appropriate agent or client contact for resolution.
Prioritize timely processing of high-value and time-sensitive enrollment requests, ensuring no account falls outside expected service windows.
Maintain accurate interaction logs and processing notes in the contact center platform for all handled enrollment interactions.

Eligibility Verification & Reconciliation

Verify member eligibility data for newly enrolling groups and individuals, cross-referencing carrier confirmations, employer rosters, and enrollment platform records.
Identify eligibility discrepancies between enrollment submissions, carrier records, and internal systems, and initiate correction workflows promptly.
Coordinate directly with carriers on enrollment confirmation, effective dates, ID card issuance, and coverage discrepancies.
Support open enrollment administration tasks including roster audits, dependent verification, and late entrant documentation review.

Documentation & Data Management

Maintain organized and current digital client files in SharePoint / Google Drive for all assigned accounts.
Prepare and route DocuSign packets for enrollment agreements, group applications, and change forms for agent review prior to client distribution.
Conduct regular data quality audits on client records in DataSource and Employee Navigator to identify and correct missing, outdated, or inconsistent information.
Ensure all eligibility and enrollment documentation is filed, named, and version-controlled in accordance with CBC's document management standards.

Seasonal Quoting Support (Secondary Function — Q4/OEP)

Assist the primary quoting team with overflow quoting requests during peak enrollment periods.
Pull and prepare carrier quote requests using established templates and carrier portal access, submitting completed quotes for agent review.
Organize and file completed quote packages in the appropriate client folders and update quoting logs in Monday.com.
Flag urgent or time-sensitive quoting requests for immediate prioritization by the primary quoting staff.

Reporting & Process Adherence

Maintain accurate processing logs and contribute to weekly eligibility and enrollment volume reports for the Sales Operations Manager.
Follow all established CBC workflows, SOPs, and documentation standards consistently and without exception.
Flag process gaps, data discrepancies, or compliance concerns to the Sales Operations Manager promptly.
Participate in regular team check-ins, process training, and performance review sessions.

Technology Skill Base

Contact Center Platform

Zoom Contact Center: Required proficiency in working assigned enrollment queues, logging interactions, and maintaining accurate queue handling records.

Benefits Administration & Eligibility Platforms

Employee Navigator: Required proficiency in account and member setup, ongoing eligibility updates, QLE management, roster audits, and member record maintenance.
DataSource: Required proficiency in account and member setup, ongoing eligibility updates, enrollment tracking, document retrieval, and eligibility data management.
Zywave: Familiarity with benefit plan documents, renewal timelines, and carrier coordination features.

CRM & Pipeline Management

HubSpot / Monday.com: Proficiency in updating contact records, queue and quoting tracking logs, and pipeline stage notes.

Document Management & Compliance

DocuSign: Comfortable preparing and routing electronic signature packets for enrollment and change forms.
SharePoint / Google Drive: Proficient in organized digital file management, document naming conventions, and version control.

Communication & Collaboration Tools

Microsoft Teams / Zoom / Slack: Proficient in virtual team collaboration, real-time communication, and asynchronous coordination with U.S.-based staff.
Outlook / Gmail: High proficiency in professional email communication, scheduling, and follow-up management.
PDF Editors: Ability to prepare, annotate, and organize enrollment forms and compliance documentation.

Data & Reporting Tools

Microsoft Excel / Google Sheets: Competent with formulas, filters, and data validation for eligibility and enrollment tracking and reporting.

Qualifications

Education

Associate or bachelor's degree in Business Administration, Health Administration, or a related field preferred. Equivalent experience in insurance operations, eligibility administration, or benefits administration will be considered.

Experience

2+ years of experience in insurance eligibility administration, enrollment processing, or a closely related benefits operations role.
Direct experience managing eligibility and enrollment for small group health insurance accounts is strongly preferred.
Experience supporting a U.S.-based insurance brokerage or benefits firm strongly preferred.
Prior Microsourcing experience or familiarity with remote U.S.-aligned work environments a plus.
Experience working with Zoom Contact Center, CRM systems, and eligibility/enrollment platforms in a production environment preferred.

Technical Proficiency
Required: Employee Navigator experience, including account setup and ongoing eligibility management.
Required: CRM experience (e.g., HubSpot, Salesforce, or similar platform).
Required: Microsoft Office Suite (Excel, Outlook, Word) and Google Workspace.
Preferred: Zoom Contact Center or comparable contact center platform experience.
Preferred: DocuSign and digital document workflow experience.
Skills Eligibility & Enrollment Management
Strong working knowledge of the full eligibility lifecycle — account setup, ongoing maintenance, and issue resolution — for small group accounts.
Ability to independently manage account and member setup in Employee Navigator and DataSource with a high degree of accuracy.
Ability to identify incomplete or non-compliant enrollment submissions and initiate appropriate resolution steps.
Experience managing multiple enrollment queues or workstreams simultaneously with accuracy and speed.
Attention to Detail & Accuracy
High level of accuracy in eligibility data entry, form review, and ongoing record management across multiple systems.
Ability to identify data discrepancies between eligibility platforms, carrier confirmations, and employer rosters.
Strong documentation discipline with consistent follow-through on assigned workflows and deadlines.
Organization & Time Management
Exceptional organizational skills with ability to manage high queue volume, multiple account types, and competing deadlines.
Ability to prioritize effectively in a fast-paced eligibility and enrollment environment, particularly during Q4 and OEP peak periods.
Communication & Team Collaboration
Professional written and verbal English communication skills required for daily interaction with U.S.-based team members.
Collaborative and responsive with proactive communication about workload status, processing blockers, and queue concerns.
Comfortable working across time zones with both asynchronous and real-time communication tools.
Technical Adaptability
Comfortable learning and navigating new platforms, systems, and carrier portals as CBC's operations evolve.
Able to follow detailed SOPs and contribute improvement suggestions for ongoing process optimization.
Knowledge Eligibility & Enrollment Knowledge
Working understanding of the full small group eligibility lifecycle, including account setup, ongoing maintenance, and termination processes.
Familiarity with QLE processing, late entrant rules, dependent verification, and mid-year enrollment change workflows.
Understanding of level-funded and fully insured small group enrollment processes and how each affects documentation and carrier submission requirements.
Compliance Awareness
General awareness of HIPAA privacy standards as they apply to handling member and eligibility data.
Understanding of ACA small group enrollment rules, effective date requirements, and carrier participation thresholds.
Understanding of the importance of documentation accuracy for regulatory, carrier audit, and compliance purposes.
Tools / Technology
Zoom Contact Center
Employee Navigator, DataSource, Zywave
HubSpot CRM, Monday.com
Microsoft Teams, Zoom meetings, Slack
Excel, Google Sheets, PDF editors, DocuSign
SharePoint, Google Drive, Outlook, Gmail

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About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines.

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