Job Details

We are looking for a detail-oriented and innovative EDI Reconciliation Analyst to join our team. In this role, you will collaborate with internal teams to analyze discrepancies in the eligibility reconciliation process for various stakeholders. You will also drive continuous improvements in thisprocess while ensuring accurate handling of Enrollment, Payment, UIR, and RBM casework.

Key Responsibilities:

• Utilize creative thinking to develop effective solutions that meet business needs and requirements.

• Create and maintain technical documentation that clearly outlines requirements and business processes.

• Review training materials for clarity and accuracy, ensuring that all documentation is up to date.

• Conduct thorough reviews, analysis, and dispositions of Enrollment, Payment, or UIR cases with 95% accuracy on a monthly basis.

• Act as a subject matter expert, contributing to the modernization of casework user interfaces to enhance analysis, quality assurance, and reporting.

• Develop test cases and identify new scenarios for quality assurance purposes.

• Foster a positive team environment, serving as a liaison among Enrollment Disputes, HICS Direct Disputes, and Rules development teams.

• Apply critical thinking skills to manage complex cases effectively.

• Address agent broker fraud scenarios impacting consumers regarding 1095-A or issuer disputes.

• Showcase excellent multitasking abilities while adapting to deadlines and team goals.

• Monitor deliverables to ensure timely completion of assigned cases.

• Prioritize initiatives based on business needs and requirements.

• Resolve issues promptly and accurately, escalating as necessary.

• Exhibit excellent verbal and written communication skills.

• Demonstrate high organizational skills and meticulous attention to detail.

• Participate in Semi-Monthly Reviews and assist with outstanding case lists.

• Handle issuer-specific requests, providing detailed and informative responses.

• Communicate effectively with team leaders and management concerning escalated casework or issuer issues.

• Present information clearly and engagingly to various stakeholders.

• Identify and prioritize responsibilities while managing multiple tasks independently.

• Provide clear and concise answers to complex enrollment, payment, and UIR inquiries.

• Work both collaboratively and independently to meet all task deadlines.

• Adapt to changes and manage priorities effectively in a dynamic environment.

• Additional responsibilities include:

• Collaborate with technical and development teams to address identified issues promptly.

• Work closely with the technology team to escalate front-end and back-end issues.

• Communicate complex scenarios related to Marketplace enrollment records and reconciliation

Required Minimum Qualifications:

• Bachelor's Degree or equivalent experience (4 years relevant experience in lieu of a degree).

• 2 years of experience in the healthcare industry.

• 1 year of experience working with X12 transactions.

• 1 year of experience with federal data or projects from agencies such as CMS, IRS, DOD, VA, SSA, or similar.

• MUST be a US Citizen.

Only candidates meeting the required qualifications will be considered.

Preferred Qualifications:

• 1 year of experience with federal data or projects from agencies like CMS, IRS, DOD, VA, SSA, or similar.

• Knowledge of the Affordable Care Act.

• Project management experience.

• Experience with federal contracts.

• Experience with premium payment transactions.

• Experience reconciling enrollment transactions.

• Proficiency with PowerBI reports and dashboards.

• Ability to write SQL queries.

Compensation Ranges

The compensation for this position may vary based on multiple factors, including location, skill set, education level, certifications, client requirements, contract-specific affordability, government clearance level, and years of experience. Compensation is part of a comprehensive benefits package offered by ASM.

EEO Requirements

ASM is committed to maintaining a diverse workforce. We ensure that race, color, religion, sex, disability, age, sexual orientation, or national origin do not impact employment decisions. All recruitment, hiring, training, and promotions occur without bias, adhering strictly to the principles of equal employment.

Physical Requirements

The physical requirements for this role are representative of what must be met by an employee to perform the primary functions successfully. Reasonable accommodations may be made for individuals with qualifying disabilities.

Disclaimer

This job description aims to convey the general nature of the work performed at this level. It is not intended to be a comprehensive list of all duties, responsibilities, or qualifications associated with this job.

Salary range: 69,700 - 80,000