EDI Analyst

Working in partnership with internal teams, The SBE Disputes EDI Analyst will also be responsible for analysis of discrepancies in the SBE payment dispute process for multiple stakeholders and continuous process improvement of the payment dispute process as well as disposition payment casework with accuracy. He / she will be investigating and providing root cause analysis updates, providing solutions, and drafting issuer responses for complex cases.

Key Responsibilities :

Review, analyze, and disposition Payment cases with 95% plus accuracy monthly.

Must have a positive attitude and be open to providing solutions and improvements.

Ability to work with complex cases and apply critical thinking skills.

Ability and willingness to think outside of the box and determine creative solutions to business needs / requirements.

Proven ability to multi-task while ensuring flexibility to meet deadlines and support team goals.

Monitor deliverables and ensure timely completion of cases assigned.

Prioritizing initiatives based on business needs and requirements.

Work to resolve issues in a timely and accurate manner and escalate as appropriate.

Excellent verbal and written communication skills.

High organizational skills and attention to detail.

Participate in review and delivery of recurring reports including the Semi-Monthly Issuer Report and Dispute Disposition Report (DDR).

Ability to efficiently work on issuer specific requests and provide timely and detailed responses.

Communicate with team leader and management team regarding escalated casework or issuer concerns.

Ability to deliver presentations in a clear, concise, and engaging manner.

Ability to identify and prioritize responsibilities while completing multiple tasks independently.

Effectively answers complex enrollment and payment questions in a clear and concise written and verbal manner.

Works effectively in a team and independently to complete all tasks in a timely manner with minimal oversight.

Review documented training material, including policy and process documents, for review and accuracy.

Handle ambiguity and change, manage priorities and tasks in a changing environment.

Work with the technical and development team to resolve identified issues in a timely manner.

Work closely with technical team and escalate all the front and backend Issues.

Be able to communicate complex scenarios related to Marketplace enrollment records and reconciliation.

Required minimum qualifications :

Bachelor's Degree or equivalent OR 4 years' relevant experience in lieu of degree.

2 additional years of experience in the health care industry.

Must be a US Citizen

Candidates that do not meet the required qualifications will not be considered.

Preferred qualifications :

1 year of experience with X12 transactions

1 year of experience with federal data or projects (including but not limited to agencies such as CMS, IRS, DOD, VA, SSA or another federal agency)

Knowledge of the Affordable Care Act

Project management experience

Experience with Federal contracts

Experience with premium payment transactions

Experience in reconciliation of enrollment transactions

Experience with Power BI Reports and Dashboards

Experience with Microsoft Office Suite

Experience with SQL queries

Compensation Ranges

Compensation ranges for ASM Research positions vary depending on multiple factors; including but not limited to, location, skill set, level of education, certifications, client requirements, contract-specific affordability, government clearance and investigation level, and years of experience. The compensation displayed for this role is a general guideline based on these factors and is unique to each role. Monetary compensation is one component of ASM's overall compensation and benefits package for employees.

EEO Requirements

It is the policy of ASM that an individual's race, color, religion, sex, disability, age, sexual orientation or national origin are not and will not be considered in any personnel or management decisions. We affirm our commitment to these fundamental policies.

All recruiting, hiring, training, and promoting for all job classifications is done without regard to race, color, religion, sex, disability, or age. All decisions on employment are made to abide by the principle of equal employment.

Physical Requirements

The physical requirements described in "Knowledge, Skills and Abilities" above are representative of those which must be met by an employee to successfully perform the primary functions of this job. (For example, "light office duties' or "lifting up to 50 pounds" or "some travel" required.) Reasonable accommodations may be made to enable individuals with qualifying disabilities, who are otherwise qualified, to perform the primary functions.

Disclaimer

The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

60,200 - 80,000

EEO Requirements

It is the policy of ASM that an individual's race, color, religion, sex, disability, age, gender identity, veteran status, sexual orientation or national origin are not and will not be considered in any personnel or management decisions. We affirm our commitment to these fundamental policies.

All recruiting, hiring, training, and promoting for all job classifications is done without regard to race, color, religion, sex, veteran status, disability, gender identity, or age. All decisions on employment are made to abide by the principle of equal employment.