Eligibility and Risk Specialist

Job overview

The Eligibility and Risk Specialist role is onsite in Valencia, CA, with pay of $19–$20 per hour. Shield HealthCare provides healthcare services and medical supply support to consumers and the caregiving community. The specialist verifies health-plan eligibility and risk delegation, maintains customer records, and researches claim rejections and denials. The role helps resolve billing issues through corrected claims or appeals, payer communication, accurate account updates, and timely follow-up.

What you'll do

• Verify eligibility and risk delegation
• maintain customer records
• research eligibility-related rejections and denials
• review payer billing requirements
• prepare corrected claims or appeals
• recommend write-offs when requirements are unmet
• communicate with payers and internal staff
• update accounts and complete assigned reports and projects.

What we're looking for

Skills & competencies

eligibility and risk specialist

health plan eligibility

claims

billing

denials

accounts receivable

microsoft excel

valencia ca

shield healthcare

$19–$20/hr

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision
• 401(k) with company match
• sick and vacation days
• flexible spending account
• life and disability insurance
• education assistance
• employee referral program.

About the employer

Shield HealthCare is hiring for this role. Industry: All Other Health and Personal Care Retailers. Sector: 45.