Seasonal Customer Service Quality Policy Analyst I

ASM Research•Remote,

18d•Remote

About The Position

The Seasonal Customer Service Quality Policy Analyst I supports case analysis and reconciliation of health insurance exchange data as part of a fully remote team. The role requires independent work, confidentiality when handling sensitive consumer information, flexibility, initiative, sound judgment, and close attention to detail. Analysts manage complex consumer enrollment disputes, investigate eligibility and processing discrepancies, and coordinate with technical and development teams to resolve issues. They also review procedures and training materials, support end-user training, and recommend improvements to case adjudication and reconciliation workflows. The work is investigative and varied, with ownership of assigned cases and a focus on resolving each case accurately rather than processing high volumes of repetitive work. A typical day includes reviewing and triaging assigned cases and escalations; investigating eligibility records and discrepancies; processing 834 file submissions through Advanced Resolution; coordinating with stakeholders and technical teams; supporting colleagues and training activities; documenting findings; and identifying opportunities for continuous process improvement. Candidates must have an associate degree, or a high school diploma/GED and relevant experience, meet additional relevant-experience requirements, be a U.S. citizen, and pass a federal background investigation granting access to government systems. The position is remote. Compensation varies based on factors including location, skills, education, certifications, client requirements, contract affordability, investigation level, and experience; no specific salary range is provided.

Requirements

Associate degree, or high school diploma/GED and 2 years of relevant experience.
2 years of additional relevant experience.
Must be a U.S. citizen.
Must be able to pass a federal background investigation that grants access to government systems.
Ability to work independently and maintain confidentiality of information.
Flexibility and engagement to meet daily expectations and adapt to changing casework.
Proactive approach, sound judgment, strong initiative, and close attention to detail.

Nice To Haves

Experience with the Affordable Care Act.
Strong written and oral communication skills.
Advanced customer service telephone skills and willingness to make outbound and receive inbound calls.
Experience with complex data analytics and advanced problem solving.
Proficiency in Microsoft Word, Excel, PowerPoint, and SharePoint.
Experience with Federal contracts.
Experience with the 834 enrollment transaction process.
Ability to remain engaged in a remote work environment.

Responsibilities

Troubleshoot, remediate, coordinate, escalate, track, and manage complex consumer enrollment disputes efficiently and in a timely manner.
Conduct research and workflow investigations, review business procedures, and recommend improvements to casework adjudication.
Identify and solve customer information and processing problems.
Apply triage, research, collaboration, and technical knowledge to resolve transaction and processing issues.
Analyze discrepancies in the eligibility reconciliation process for multiple stakeholders.
Serve as a subject matter expert regarding the Health Insurance Marketplace.
Provide day-to-day guidance to assigned team members when appropriate.
Coordinate with technical and development teams to resolve identified issues in a timely manner.
Review documented training materials for accuracy and assist with end-user training and support.
Drive continuous process improvement of the reconciliation process.
Provide content for, and collaborate with, training staff to train stakeholders on transaction triage and reconciliation.
Process 834 file submissions through Advanced Resolution.
Undertake additional duties as assigned by the Manager.