Enrollment Data Analyst

Role Overview

• 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
• 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
• 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
• 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
• 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

Requirements

• 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.

Tech Stack

• SQL

Benefits

• 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.