Manager, EDI & Eligibility

AmeriLife•Overland Park, KS

About The Position

The Manager, EDI & Eligibility oversees the daily operations of the EDI and eligibility processes within the TurnKey benefits administration and enrollment system. This role also serves as a data specialist providing support to clients and internal staff in the generation of data files and ongoing maintenance of data in relation to our client’s employees and their supplemental insurance policies. The EDI & Eligibility Manager will perform various tasks including database updates on both our TurnKey enrollment and VUE billing platforms, creating reports and integrations within the systems, performing quality analysis evaluations and audits on data and system functionality periodically to ensure the accuracy of the database and reports as well as importing data from internal and external sources.

Requirements

Bachelor’s Degree Preferred
Full understanding and minimum 2 years experience in insurance industry concepts, practices, procedures, eligibility and product behaviors
Experience in Microsoft office Suite (Excel, Word, Outlook). Advanced Excel knowledge is a necessity
Previous supervisory or management experience
Skilled in process improvements
Data reconciliation skills
Strong organizational skills
Attention to detail and the ability to work efficiently under deadline pressure is essential
Able to multitask, prioritize, and manage time efficiently
Able to work in a fast-paced, team environment as well as independently
Java Scripting Experience a must
Strong interpersonal skills; effective oral and written communications both internally and externally
Flexibility and adaptability; energetic and self-driven
Skills in multiple aspects of data work including entry, analysis, reconfiguration, and data management

Responsibilities

Manage and Supervise EDI & Eligibility Specialists
Maintain accurate file processing schedule and meet multiple deadlines
Process file imports and exports
Process error and results reports received after file postings
Setup new integrations and reports
Analyze file setup configurations and account structures
Troubleshoot and resolve file transmission issues including mapping errors and data mismatches
Compare data against policy and proposal to identify discrepancies
Database setup of new and existing client account structure and configurations
Testing new and existing clients system functionality and reporting after setup or changes occur
Processing open enrollment system configurations and reporting structure changes
Develop and maintain documentation related to eligibility file specs, file layouts, business rules and escalation protocols
Identify and implement improvements to workflows and systems to enhance efficiency and productivity
Identify and propose necessary development changes to existing EDI, COBRA and Payroll reports as requested and approved
Research and resolve report bugs as identified
Provide and/or point users to resources on report inquires or user errors as needed
Develops and maintains training manuals related to EDI, eligibility, and discrepancy processes
Trains departments on EDI, eligibility and discrepancy processes and continues to provide best practice recommendations
Gather requirements, specs and codes and review to provide hours, resource needs and ETA for build and implementation
Participate in carrier EDI setup calls as needed
Research and Resolve Selerix to VUE Data Sync Discrepancies and assist the Developer in maintaining the necessary enhancements/maintenance to stay in line with business needs
Manage billing discrepancy carrier checks
Identify development changes to existing EDI, COBRA and Payroll reports as requested and approved