Eligibility Analyst I

MedImpact•San Diego, CA

1d•Onsite

About The Position

The Eligibility Analyst I serves as a liaison between Account Management and the Eligibility Department and processes daily client eligibility files. The role performs quality assurance validation to verify file-load accuracy, data integrity, completeness, and compliance with processing requirements; analyzes and remediates record exceptions; and monitors file activity and errors to ensure timely, accurate ingestion. The analyst collaborates with internal stakeholders to validate requirements, resolve processing issues, and drive issue resolution. This position provides day-to-day production support to Account Management and serves as a centralized eligibility subject matter expert for strategic partners. It also supports audits and SOX compliance, contributes to technical system enhancements with IT Data Exchange, maintains eligibility reference documentation, and verifies batch-file processing and delivery for TPAs and Commercial Carriers. The role is full-time and non-exempt. Typical hours are Monday through Friday, 8:00 a.m. to 5:00 p.m., with overtime and the ability to work nights, weekends, or holidays as business needs require. The position is based on-site at the San Diego Headquarters or another company location; remote work may be approved by management based on business requirements. No travel is required, though attendance at local conferences and meetings may be required.

Requirements

BS/BA and at least 1 year of experience, or an equivalent combination of education and experience.
Intermediate to advanced knowledge of Microsoft Office Suite.
Experience using Pharmscreens, EPSROI, and COB File Manager is required following training.
Ability to solve practical problems and interpret instructions provided in written, oral, diagram, or schedule form.
Ability to perform basic arithmetic and calculate rates, ratios, and percentages, and interpret bar graphs.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to effectively present information in one-on-one and small-group situations.
Ability to sit, talk or hear, stand, walk, use hands to handle or feel objects, and reach with hands and arms; occasionally lift or move up to 25 pounds.
Ability to maintain close visual acuity for reading fine print, viewing computer screens, and handling small objects; adequate color vision and depth perception are also required.
Ability to work overtime from time to time, including nights, weekends, or holidays as required.

Nice To Haves

Data analysis experience.
Healthcare eligibility experience.

Responsibilities

Be accountable for performance guarantees.
Assist with audits and SOX compliance.
Oversee and quality-review eligibility file loads.
Validate eligibility file loads for data integrity, completeness, and adherence to established processing requirements.
Analyze and manually remediate eligibility record exceptions and data discrepancies to support accurate downstream processing.
Coordinate with Account Management to validate file requirements, resolve processing issues, and ensure timely, accurate eligibility file ingestion.
Research and perform more complex cleanup activities related to eligibility and synchronization issues with appropriate parties.
Provide primary day-to-day operational production support for Account Management and serve as the centralized eligibility subject matter expert for strategic partners.
Collaborate with IT Data Exchange on system enhancements for error-log handling, failed member-record reprocessing on behalf of clients, and automated file monitoring and alerts.
Write and maintain detailed eligibility reference documentation.
Oversee verification that TPA and Commercial Carrier batch-file processing requests are completed, validate file delivery status, or manually post files to secure FTP directories.