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27 Nov 2019

Full-Time Member Enrollment Analyst

RecruitDQ – Posted by RecruitDQ Boston, Massachusetts, United States

Job Description

The Member Enrollment Analyst handles all processes related to membership, including eligibility EDI (EE), online enrollment (OE), and manual requests, and ensures membership accuracy within the system. Works collaboratively with external clients on their EE and OE submissions to provide education and ensure standards are met. Researches and resolves membership issues through professional interaction with appropriate external client contacts and other internal stakeholders. Handles clients’ membership implementations, from onset to implementation, and maintains consistent communication to stakeholders.



  • Document client-specific eligibility business rules using tools such as Word, Visio and Excel; communicate business rules to IT.
  • Understand and utilize the IT applications and tools used to support data mapping, business rules, and HIPAA compliance; work with IT to implement technical aspects of system and data configurations based on business rules.
  • Manage new eligibility EDI (EE) implementations and changes to existing clients’ EE files through conference calls, e-mails, on-site visits, and ongoing customer communication.
  • Maintain DentaQuest HIPAA 834 and Proprietary Companion Guides that enables clients to comply with processing requirements and reduce errors.
  • Manage a high volume of tasks with competing priorities.
  • Partner with IT to diagnose, perform user acceptance test (UAT), and approve code fixes into production.
  • Provide superior customer service by responding to client membership-related inquiries in a timely and accurate manner; may require extensive research with diverse resources.
  • Establish and maintain membership data via EE files; manage timely and accurate processing of files to ensure all systems have correct data.
  • Analyze incoming EE files to confirm file format requirements are met; educate customers.
  • Support Online Enrollment application by working directly with clients on setup, maintenance and problem solving; handle OE phone calls.
  • Provide superior customer service by handling the membership/eligibility phone line; address callers’ needs timely and accurately.
  • Identify EDI solutions to business needs and constantly improve the effectiveness of our communications as they relate to eligibility and membership.
  • Proactively communicate and coordinate eligibility issues with Sales, Client Services, Customer Service and impacted departments; work collaboratively with these departments to develop solutions.
  • Accurately establish and maintain membership data for new and existing members through paper/manual process in accordance with processing guidelines and standards; meet department SLA’s for turnaround times and quality.
  • Support company goals by participating on and providing membership expertise to departmental and company projects.
  • Assist clients in the interpretation and management of membership and eligibility reports.
  • Other duties as needed or required.


  • Required Associate’s Degree plus 2 years related EDI or Business Analyst experience.
  • Possess strong analytical and creative problem solving skills.
  • Excellent verbal and written communication skills.
  • Excellent organizational and time management skills.
  • Ability to analyze and interpret EDI files Ability to work independently without close supervision.
  • Demonstrates self-motivation by taking initiative to learn more and take on more challenges.
  • Use decision making skills to prioritize effectively.
  • Embrace change; positively influence change.
  • Microsoft Office (Word, Excel).
  • Understanding of SSIS and ‘source to target’ data mapping.
  • Specific knowledge of enrollment processes in a commercial, Medicaid, or Medicare Health Plan/TPA organization.
  • Working knowledge of FTP.
  • Required to attend additional training as requested/deemed necessary.


  • Bachelor’s degree preferred Knowledge of HIPAA 834 transaction a plus.


  • Incumbent must be able to communicate effectively.
  • Requires overall light physical effort (up to 25lbs.)
  • Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
  • Ability to travel or move about within and outside serviced facilities required.
  • Incumbent works primarily in either a private or shared office environment.

How to Apply

To be considered for this role, please apply here:

Job Categories: Equal Opportunities. Job Types: Full-Time.

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