Responsibilities

• Collaborate with the Assistant Director, Model Office Team, and IT Applications Development Team to support key Eligibility Department initiatives from an analysis and testing perspective
• Develop business test cases to test system logic changes and program modifications to ensure logic is operating according to business guidelines and design specifications
• Conduct User Acceptance Testing (UAT) for various Eligibility projects and analyze and document test results
• Develop ad-hoc data reports, using PL/SQL, in support of Eligibility initiatives
• Review, monitor, and analyze eligibility systemic data reports, vendor export files, and pre-edit reports for active working members, dependents, and retirees/spouses to ensure data integrity
• Review and monitor daily Eligibility Control reports and Eligibility Nightly Batch to ensure members are not incorrectly downgraded, suspended/terminated, and to report system discrepancies and anomalies
• Create data comparison analysis, reconciliation, review, and monitor systematic data reports to ensure the quality and integrity of the eligibility/enrollment data and evaluate results and report findings with recommendation for corrective action
• Support staff training and development by conducting eligibility training and testing protocols
• Develop, create and maintain standard operating procedures related to testing, quality assurance and controls and V3 eligibility logic rules across other functional areas
• Respond in a timely manner to the eligibility system and external vendor system/files for member inquiries (internal and external) via email, phone, and/or hard copies
• Perform additional duties and projects as assigned by management

Qualifications

• Bachelor’s degree or equivalent years of work experience required
• Minimum of four (4) years’ experience in data analysis (gathering and analyzing data for problems and issues)
• Demonstrated experience extracting and analyzing large-scale health data sets using PL/SQL
• Advanced level in MS Excel and Word; proficiency in PL/SQL required
• Proven experience in conducting application/systems testing and reviewing and analyzing requirements
• Experience with healthcare enrollment, eligibility, health coverage, Coordination of Benefits (COB), or Consolidated Omnibus Budget Reconciliation Act (COBRA) in a health insurance or benefits environment a plus
• Strong Interpersonal skills with attention to detail and accuracy; ability to interact and communicate well with all levels of staff; must be a strong critical thinker
• Ability to work well in a team environment, meet tight deadlines and handle several projects simultaneously
• Available to work evenings and weekends as needed