Manager, EDI & Eligibility

AmeriLife • Overland Park, KS

8d

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

Benefits

• A comprehensive benefits package that includes PTO, medical, dental, vision, retirement savings, disability insurance, and life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager