Job Description

Responsibilities

• Support key Eligibility Department initiatives from an analysis and testing perspective
• Develop business test cases to test system logic changes and program modifications to ensure logic is operating according to business guidelines and design specifications
• Conduct User Acceptance Testing (UAT) for various Eligibility projects and analyze and document test results
• Develop ad-hoc data reports, using SQL in support of Eligibility initiatives
• Review, monitor, and analyze eligibility systemic data reports, vendor export files, and pre-edit reports for active working members, dependents, and retirees/spouses to ensure data integrity
• Review and monitor daily Eligibility Control reports and Eligibility Nightly Batch to ensure members are not incorrectly downgraded, suspended/terminated, and to report system discrepancies and anomalies
• Create data comparison analysis, reconciliation, review, and monitor systematic data reports to ensure the quality and integrity of the eligibility/enrollment data and evaluate results and report findings with recommendation for corrective action
• Respond in a timely manner to the eligibility system and external vendor system/files for member inquiries (internal and external) via email, phone, and/or hard copies
• Perform additional duties and projects assigned by management

Qualifications

• Bachelor’s degree or equivalent years of work experience required; plus
• Minimum of four (4) years experience in data analysis (gathering and analyzing data for problems and issues)
• Ability to write and modify SQL queries to extract and analyze data
• Demonstrated experience extracting and analyzing large-scale health data sets using SQL
• Advanced level in MS Excel required; and working knowledge of MS Word
• Proven experience in conducting application/systems testing and reviewing and analyzing requirements
• Experience with healthcare enrollment, eligibility, health coverage, Coordination of Benefits (COB), or Consolidated Omnibus Budget Reconciliation Act (COBRA) in a health insurance or benefits environment a plus
• Strong Interpersonal skills with attention to detail and accuracy; ability to interact and communicate well with all levels of staff; must be a strong critical thinker
• Ability to work well in a team environment, meet tight deadlines and handle several projects simultaneously