Enrollment Data Analyst

Key Responsibilities

834 EDI Exchange & Enrollment Processing 
• Configure, monitor, and troubleshoot inbound and outbound HIPAA 834 (Benefit Enrollment and Maintenance) transaction files with trading partners, employers, and TPAs
• Validate 834 file structures for compliance with X12 5010 standards, identifying and resolving segment errors, loop discrepancies, and rejected transactions
• Coordinate with trading partners to resolve enrollment exchange issues and ensure timely, accurate file transmission
Data Validation & Quality Assurance
• Perform systematic validation of member enrollment records against source documents, 834 transactions, and plan eligibility rules
• Identify data anomalies, duplicate records, coverage gaps, and demographic inconsistencies
• Execute data quality audits on a scheduled and ad-hoc basis, documenting findings and remediation steps
• Ensure enrollment data aligns with plan effective dates, benefit periods, and group contract terms
Data Entry & Maintenance
• Accurately enter and update member demographic, eligibility, and coverage data across the web UI enrollment portal and the claims processing system
• Process member adds, terminations, changes, and reinstatements in a timely manner in compliance with CMS and ACA guidelines
• Maintain supporting documentation for all manual data changes per audit and compliance standards
Data Cleanup & Remediation 
• Lead targeted data cleanup projects to address backlogs, legacy migration issues, and discrepancies identified through audits or operational escalations
• Write and execute SQL queries against enrollment and member databases to identify, extract, and correct data issues
• Collaborate with the engineering team on bulk update scripts and data remediation workflows 
Cross-Functional Collaboration 
• Partner with engineering, claims, and population health teams to surface enrollment data issues affecting downstream claim adjudication, reporting, and care management workflows
• Support compliance and reporting requirements including ACA 1095-B and CMS enrollment submissions
• Communicate enrollment discrepancies and resolution status to internal stakeholders and external partners 

Required Qualifications

• 2+ years of experience in health plan enrollment operations, managed care, or EDI data processing
• Hands-on experience with HIPAA 834 transaction processing and X12 EDI standards
• Proficiency with SQL-- able to write queries to retrieve, validate, and correct enrollment data directly against relational databases
• Experience working within claims administration systems (e.g., Plexis QC, QNXT, TriZetto, HealthEdge, or similar). 
• Strong attention to detail with a proven ability to manage high volumes of data accurately 
• Familiarity with ACA eligibility and enrollment rules, CMS guidelines, and HIPAA data privacy 

Preferred Qualifications

• Experience with web-based enrollment portals or member engagement UIs
• Understanding of downstream impacts of enrollment data on claims adjudication and provider rosters
• Exposure to EDI mapping tools or translation software (e.g., Edifects, BizTalk, or Claritev). 
• Familiarity with population health platforms or care management systems
• Experience supporting IRS Form 1095 or CMS risk adjustment data submissions 

Tools & Systems

Category

Examples

EDI / Enrollment Exchange

834 X12 5010, trading partner portals, Claritev

Enrollment Web UI

Internal member management portal

Claims System

Health plan claims adjudication platform

Database

SQL Server (direct query access)

Office Productivity

Excel, SharePoint, ticketing systems

Competencies

• Data Accuracy— Treats data integrity as mission critical; catches errors before they propagate
• Problem Solving— Traces enrollment issues to root cause across EDI, UI, and database layers
• Communication— Translates technical data issues into clear, actionable summaries for non-technical stakeholders
• Urgency & Organization— Manages competing priorities, meets SLAs for enrollment processing windows
• Collaboration— Works fluidly across operations, engineering, and compliance teams   

Work Environment

This is a fully remote position. Candidates must reside in the United States within the Central (CST) or Eastern (EST) time zone.
Standard business hours are Monday through Friday, 9:00 AM – 5:00 PM CST, with occasional flexibility required to meet regulatory response deadlines.
Must maintain a dedicated, private workspace that is separate from other living areas and supports the secure handling of confidential information.
Must have a reliable high-speed internet connection.
All company-sensitive documents must be kept secure and handled in accordance with Evry Health data privacy and security policies.