What are the responsibilities and job description for the Analyst, Enrollment and Eligibility Operations position at BrightonOne?
Title: Analyst, Enrollment and Eligibility Operations
Job Type: Full-time
Location: Hybrid — 4 days per week in Brighton, MA office; 1 day remote
FLSA Status: Exempt
About Us
BrightonOne is a nonprofit social enterprise delivering healthcare, housing, and hope to veterans and military-connected families, with enterprise discipline in service to those who served.
Position Summary
The Analyst, Enrollment and Eligibility Operations performs the back-office transactions and analysis that keep USFHP's enrollment, eligibility, and billing accurate and compliant. Working from established procedures, the Analyst processes enrollment, disenrollment, and change transactions, reconciles member eligibility against DEERS and TRICARE rules, analyzes billing and premium activity, and researches and resolves discrepancies — safeguarding data integrity across the member lifecycle and supporting timely, compliant operations.
Key Responsibilities
Enrollment & Eligibility Processing
- Process enrollment, disenrollment, and demographic/coverage change transactions accurately and within required timeframes.
- Work with Provider Network team to identify members impacted by changes in Primary Care Provider network.
- Reconcile member and eligibility data against DEERS and TRICARE eligibility rules; identify, research, and resolve discrepancies.
- Maintain accurate member records across enrollment, eligibility, and membership systems.
Billing & Premium Analysis
- Set-up recurring premium billing methods (allotments, EFT, Credit Card) based on member election and/or TRICARE Policy.
- Analyze billing, premium, and payment activity; research and resolve billing discrepancies and exceptions.
- Support premium reconciliation, refunds/adjustments, and related reporting.
Reconciliation, Reporting & Audit
- Perform routine reconciliations between membership, eligibility, and billing systems and government files.
- Prepare data and documentation to support audits and operational reporting.
Coordination & Compliance
- Coordinate with customer experience, finance, and vendors to resolve member enrollment and billing issues.
- Maintain documentation and handle member data in compliance with TRICARE/USFHP and HIPAA standards.
Qualifications
Education & Experience
- High school diploma/GED required; Associate's or Bachelor's degree preferred.
- 2–5 years of enrollment, eligibility, billing, or health plan operations experience.
Skills & Competencies
- Strong data accuracy, reconciliation, and analytical skills.
- Proficiency with Excel and membership/billing/enrollment systems.
- Knowledge of enrollment/eligibility and premium billing processes.
- Detail orientation and problem-solving;
- Familiarity with TRICARE/USFHP and DEERS preferred.
Other Requirements
- Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.
Physical Nature of the Job
Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move throughout the campus.
Equal Opportunity Employer Statement
BrightonOne is an Equal Opportunity Employer. We prohibit discrimination and harassment of any kind based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, protected veteran status, or any other characteristic protected by federal, state, or local law. We strongly encourage applications from veterans and individuals with disabilities. Accommodations are available upon request for candidates taking part in all aspects of the selection process.
Work Authorization
Candidates must be authorized to work in the United States without sponsorship now or in the future.
Compensation: $70,000-85,000 annually
Salary : $70,000 - $85,000