EDI Analyst

ASM Research

12h

About The Position

Working in partnership with internal teams, The Issuer Disputes EDI Analyst will also be responsible for analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process as well as disposition Enrollment, Payment, UIR and the RBM casework with accuracy. He/she will be investigating and providing root cause analysis updates, provide solutions, and draft issuer responses for complex cases or around consumer matching data and rule-based model creation.

Requirements

Bachelor’s Degree or equivalent OR 4 years’ relevant experience in lieu of degree.
2 additional years of experience in the health care industry.
Must be a US Citizen.

Nice To Haves

1 year of experience with X12 transactions
1 year of experience with federal data or projects (including but not limited to agencies such as CMS, IRS, DOD, VA, SSA or another federal agency)
Knowledge of the Affordable Care Act
Project management experience
Experience with Federal contracts
Experience with premium payment transactions
Experience in reconciliation of enrollment transactions
Experience with PowerBI Reports and Dashboards
Experience with SQL queries

Responsibilities

Ability and willingness to think outside of the box and determine creative solutions to business needs/requirements.
Ability to develop and maintain technical documentation that outlines requirements and business processes.
Review documented training material, including policy and process documents, for review and accuracy.
Review, analysis, and disposition Enrollment, Payment or UIR cases with 95% plus accuracy monthly.
Act as a subject matter expert to modernize and update casework UI to better assist analysis work, QA and reporting.
Excellent ability to create test cases and identify new scenarios to test for.
Must have positive attitude and serve as a liaison between Enrollment Disputes, HICS Direct Disputes and Rules development teams and open to provide solutions and improvements.
Ability to work with complex cases and apply critical thinking skills.
Experience dealing with agent broker fraud scenarios affecting consumers on the 1095-A or issuer disputes side.
Proven ability to multi-task while ensuring flexibility to meet deadlines and support team goals.
Monitor deliverables and ensure timely completion of cases assigned.
Prioritizing initiatives based on business needs and requirements.
Work to resolve issues in a timely and accurate manner and escalate as appropriate.
Excellent verbal and written communication skills.
High organizational skills and attention to detail.
Participate in Semi-Monthly Review and assist with left over lists.
Ability to work on issuer specific requests and provide detailed responses.
Communicate with team leader and management team regarding escalated casework or issuer concerns.
Ability to deliver presentations in a clear, concise, and engaging manner.
Ability to identify and prioritize responsibilities while completing multiple tasks independently.
Effectively answers complex enrollment, payment, and UIR questions in a clear and concise written and verbal manner.
Works effectively in a team and independently to complete all tasks in a timely manner.
Handle ambiguity and change, manage priorities and tasks in a changing environment.
Work with the technical and development team to resolve identified issues in a timely manner.
Work closely with technology team and escalate all the front and backend Issues.
Be able to communicate complex scenarios related to Marketplace enrollment records and reconciliation.