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Career Opportunities



Southern California Physicians Managed Care Services is San Diego's premier provider of medical administrative services including claims payment, contracting and utilization management.

Current Career Opportunities:

Southern California Physicians Managed Care Services has the following career opportunities available:

Eligibility Analyst – EM

Department: Claims & Eligibility
Level: Non-supervisory
Reports To: Production Supervisor, Claims & Eligibility
Private Health Information (PHI): Position requires read only access to member claims and read and write access to eligibility.
Job Classification: Non-Exempt
Job Type: Full time - Four-Day 10 hour days, Monday - Thursday
Pay Rate: Salary is based on qualifications and experience
Position Summary: Processes monthly and weekly eligibility files from each health plan and medical group. Uses Eligibility Manager (EM) for scrubbing data and creation of export filed for updating eligibility in EZCap.
Essential Job Functions:
  • This description is not exhaustive and may be modified on a temporary or regular basis at the discretion of SCPMCS. SCPMCS expects that its' employees will need to assume other "non-essential functions" not listed herein which support company business objectives; this may include duties which fall outside of normal position scope
  • Uses EM to process health plan files on a weekly and monthly basis. Compares health plan files to EZCap data, making necessary changes and updates. Adds new PCPs to EM crosswalk after confirming status with Finance, adds new employer groups and options (as TBA) to EZCap.
  • Runs and review Missing Members report. Researching health plan portals to resolve discrepancies.
  • Create an EZ-Net inload files by exporting clean data from EM. Works files in EZ-Net correcting any rejects and posts eligibility into EZCap.
  • Maintains custom tables in Eligibility Manager. Notifies manager of any revisions, updates or issues with the application.
  • Assists in eligibility verification requests as needed to ensure department maintains quick turnaround times on requests.
  • Tests new versions of EZCap products and Eligibility Manager as they become available.
  • Recommends new procedures or changes to existing procedures for reconciling eligibility in the EZCap system to eligibility provided from the health plans.
  • Tests new versions of EZCap products and Eligibility Manager as they become available.
  • Position Qualifications and Requirements:
  • Experience/Specialized Skills:
        o 2 years of managed care eligibility experience.
        o Expert knowledge of Microsoft Access Database, Excel and Word programs.
        o Strong data entry skills and good verbal and written communication skills.
  • Education/Course(s)/Training: High School Diploma
  • Licensure/Certification: N/A
  • Location: Mira Mesa, San Diego
    Date Posted: May 4, 2020
    To apply for this position, click here to complete the employment application and submit it to jobs@scpmcs.org

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