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Enrollment Data Analyst

9 hours, 59 minutes ago
United States
Full-time
Junior
Data Analyst
Data Science and Analytics
SQL SQL Server
Apply Now
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised
View All Jobs 3

Description

  • Configure, monitor, and troubleshoot inbound and outbound HIPAA 834 enrollment transactions with trading partners, employers, and TPAs.
  • Validate 834 file structures against X12 5010 standards and resolve segment errors, loop discrepancies, and rejected transactions.
  • Coordinate with external partners to resolve enrollment exchange issues and ensure timely file transmission.
  • Validate member enrollment records against source documents, transaction files, and eligibility rules.
  • Identify and remediate data anomalies, duplicate records, coverage gaps, and demographic inconsistencies.
  • Perform scheduled and ad hoc data quality audits and document findings and remediation steps.
  • Enter and update member demographic, eligibility, and coverage data in the enrollment portal and claims system.
  • Process member adds, terminations, changes, and reinstatements in compliance with CMS and ACA guidelines.
  • Maintain documentation for manual data changes to support audit and compliance requirements.
  • Lead data cleanup and remediation efforts for backlogs, legacy migrations, and audit findings.
  • Write and execute SQL queries to identify, extract, and correct enrollment and member data issues.
  • Collaborate with engineering, claims, population health, compliance, and reporting teams on enrollment issues and downstream impacts.

Requirements

  • 2+ years of experience in health plan enrollment operations, managed care, or EDI data processing.
  • Hands-on experience with HIPAA 834 transaction processing and X12 EDI standards.
  • Proficiency in SQL, including writing queries to retrieve, validate, and correct enrollment data in relational databases.
  • Experience working in claims administration systems such as Plexis QC, QNXT, TriZetto, HealthEdge, or similar.
  • Strong attention to detail and ability to manage high volumes of data accurately.
  • Familiarity with ACA eligibility and enrollment rules, CMS guidelines, and HIPAA data privacy.
  • Experience with web-based enrollment portals or member engagement user interfaces is preferred.
  • Understanding of how enrollment data affects claims adjudication and provider rosters is preferred.
  • Exposure to EDI mapping tools or translation software such as Edifects, BizTalk, or Claritev is preferred.
  • Familiarity with population health platforms, care management systems, IRS Form 1095, or CMS risk adjustment submissions is preferred.
  • Must reside in the United States within the Central or Eastern time zone.
  • Must be available to work Monday through Friday, 9:00 AM to 5:00 PM CST, with occasional flexibility for regulatory deadlines.
  • Must maintain a private workspace and a reliable high-speed internet connection for secure remote work.

Benefits

  • Fully remote work arrangement.
  • Standard Monday through Friday business hours.
  • Opportunities to work on health plan operations that affect member enrollment, claims, and care management.
  • Participation in a mission-driven company focused on improving the health insurance experience.

Interested in this position?

Apply directly on the company website

Apply Now

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