Analyst, Enrollment and Eligibility Operations

BrightonONE•Brighton, MA

5d•Hybrid

About The Position

The Analyst, Enrollment and Eligibility Operations performs the back-office transactions and analysis that keep USFHP's enrollment, eligibility, and billing accurate and compliant. Working from established procedures, the Analyst processes enrollment, disenrollment, and change transactions, reconciles member eligibility against DEERS and TRICARE rules, analyzes billing and premium activity, and researches and resolves discrepancies — safeguarding data integrity across the member lifecycle and supporting timely, compliant operations.

Requirements

High school diploma/GED required
2–5 years of enrollment, eligibility, billing, or health plan operations experience.
Strong data accuracy, reconciliation, and analytical skills.
Proficiency with Excel and membership/billing/enrollment systems.
Knowledge of enrollment/eligibility and premium billing processes.
Detail orientation and problem-solving
Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.
Candidates must be authorized to work in the United States without sponsorship now or in the future.

Nice To Haves

Associate's or Bachelor's degree preferred.
Familiarity with TRICARE/USFHP and DEERS preferred.

Responsibilities

Process enrollment, disenrollment, and demographic/coverage change transactions accurately and within required timeframes.
Work with Provider Network team to identify members impacted by changes in Primary Care Provider network.
Reconcile member and eligibility data against DEERS and TRICARE eligibility rules; identify, research, and resolve discrepancies.
Maintain accurate member records across enrollment, eligibility, and membership systems.
Set-up recurring premium billing methods (allotments, EFT, Credit Card) based on member election and/or TRICARE Policy.
Analyze billing, premium, and payment activity; research and resolve billing discrepancies and exceptions.
Support premium reconciliation, refunds/adjustments, and related reporting.
Perform routine reconciliations between membership, eligibility, and billing systems and government files.
Prepare data and documentation to support audits and operational reporting.
Coordinate with customer experience, finance, and vendors to resolve member enrollment and billing issues.
Maintain documentation and handle member data in compliance with TRICARE/USFHP and HIPAA standards.