Eligibility Reconciliation Analyst

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!

Under the Manager, Business Systems Operations Support, the Eligibility Reconciliation Analyst will identify, research & resolve discrepancies between source data and IEHP eligibility data. The incumbent is responsible for identifying and resolving discrepancies in Member's demographic, enrollment, premium and eligibility data between federal and/or state data against IEHP's membership. The Reconciliation Analyst will perform a variety of duties related to membership reconciliation from various sources.

The Eligibility Reconciliation Analyst is independent and acts as a subject matter expert for Covered California eligibility.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary.

Hybrid schedule.

State of the art fitness center on-site.

Medical Insurance with Dental and Vision.

Life, short-term, and long-term disability options

Career advancement opportunities and professional development.

Wellness programs that promote a healthy work-life balance.

Flexible Spending Account - Health Care/Childcare

CalPERS retirement

457(b) option with a contribution match

Paid life insurance for employees

Pet care insurance

Education & Requirements

At least two (2) years of relevant experience: a minimum of one (1) year of experience demonstrating excellent organizational, time management, and facilitation skills required

Experience demonstrating initiative and self-direction with the ability to work well independently and in teams while serving as a Subject Matter Expert (SME) required

Also includes at least one year of eligibility research experience in a managed care setting required

Minimum of 1 year experience and knowledge of Covered California regulatory requirements and membership reconciliation preferred

Minimum of 1 year experience and knowledge of Medicare regulatory requirements preferred

Experience with Covered CA or other Exchange products preferred

Bachelor's Degree in Business Administration, Health Care Administration, Computer Information Systems (CIS), Management Information Systems (MIS), or other related field from an accredited institution required

One (1) of the following scenarios will be accepted in lieu of a Bachelor's degree:

In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position: Two (2) years of Health Care or Managed Care Operations experience and a minimum of two (2) years of data reconciliation or experience working with Eligibility data is required

This experience is in addition to the minimum years listed in the Experience Requirements above

Key Qualifications

Experience and/or knowledge of the 834-file format system preferred

Requires excellent critical thinking, root cause analysis, and problem-solving skills as well as excellent written and verbal communication skills with the ability to communicate and present effectively in large forums to discuss complex information

Also requires a high level of attention to detail

Ability to work independently and solve complex problems with little to no assistance

Effectively manage multiple competing priorities and adhere to strict timelines

Ability to effectively manage multiple competing priorities

Ability to manage multiple projects of varying complexity, priority levels and deadlines

Permanent