Eligibility data is the foundation of every member experience we deliver. In this role, you make sure enrollment and coverage information is accurate, validated, and ready to move through our systems without surprises. When the data is clean, members get the benefits they expect—and clients trust the platform behind it.

• Analyze eligibility data: Review raw eligibility and enrollment files to validate accuracy before load and identify gaps or inconsistencies that could impact coverage.
• Standardize incoming files: Combine data from multiple sources into consistent, readable formats that support downstream processing and reporting.
• Validate file accuracy: Run detailed analyses using Excel to confirm eligibility structures, certifications, departments, and billing tiers are correct.
• Resolve data issues: Identify eligibility file and data errors, determine root causes, and partner with internal teams to implement fixes.
• Run recurring censuses: Execute monthly and quarterly censuses to surface discrepancies such as invalid spouse pends (E13), overage dependents, departments, rating structures, billing tiers, ID card formats, and life volumes.
• Support vendor handoffs: Submit eligibility and coverage-specific data to downstream vendors and validate successful transmission.
• Improve eligibility processes: Contribute to designing, testing, and standardizing eligibility file workflows to improve consistency and reduce rework.
• Coordinate externally: Communicate directly with clients and external vendors to clarify eligibility data questions and resolve discrepancies.

Education & Experience

• Prior experience working with eligibility and enrollment data
• Experience supporting client-facing data processes in a healthcare, benefits, or related environment

Technical Skills

• Microsoft Excel (data analysis, file validation, reporting)
• Working with raw data files and flat files
• Eligibility and enrollment data structures
• Data validation and quality assurance processes