Claims
Analyst, Enrollment
Pune, Maharashtra, India

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

The Senior Analyst of Enrollment Operations is responsible for finding ways to improve the accurate and expedient processing of all membership transactions of On-Exchange, Off-Exchange, and various Commercial lines of health benefit administration. This requires ongoing analysis and supervision of activities and deliverables that will improve enrollment operations. This includes, but may not be limited to: new implementation support, file load processes, evaluation of existing business operations, reviewing compliance with all relevant regulatory agencies, monitoring achievement of operational service levels and other special projects. The Senior Analyst will be called upon to provide assistance to upper management for projects and special assignments, and is accountable for establishing and maintaining productive relationships with internal departments across Evolent Health.

Essential functions:

  • Assist the director in analyzing department performance and processes, and developing new operational processes and recommendations for improvements
  • Provide guidance for team and management regarding escalations and help to proactively resolve issues before they occur.
  • Develop, refine and implement effective policies and procedures, and subsequent training, to ensure all team members are able to perform properly.
  • Assist with new client implementation support to ensure timely, accurate delivery enrollment data, claim data entry, system set-up, cross-departmental communication, standard reports, and exception reporting.
  • Develop knowledge in ACA Exchange, Centers for Medicare & Medicaid Service, Self-Funded, and all other applicable regulatory agencies that govern the enrollment data both received via electronic data interface (EDI) and non-EDI.
  • Identify way to improve ongoing reconciliation of group and agency enrollment data; including proactively reporting and resolving discrepancies.
  • Assist the director in developing and analyzing appropriate team performance metrics.
  • Promote the use of accepted best practices and innovative strategies.
  • Keep abreast of changes in requirements.
  • Assist the team in resolving administrative and routine operational issues as they arise

 

Preferred functions

 

  • Understanding of X12 files, 834 files, paper enrollment, and billing/invoicing 
  • SQL knowledge (mid/basic level)
  • Understanding of claim processing environment and knowledge of claim adjudication process/concepts.
  • Experience in process improvement that utilizes six sigma, kaizen, and/or other process improvement methodologies in a transactional environment or has experience in being involved in process improvement in general that tie into measurable results.
  • Overall understanding of health care benefit administration.
  • Ability to communicate in an effective manner to drive results and maintain positive team atmosphere.
  • Ability to communicate to other internal business teams during cross-functional projects and ability to implement conflict resolution strategies.
  • Ability to document processes and/or provide guidance to business analyst to ensure proper documentation is developed.
  • The interpersonal skills necessary include the ability to work well within a team that includes all levels within the organization from clerical and support staff to senior management as well as clients and brokers outside of the organization.
  • Understands working in a health benefit administration, Third Party Administrator, or Pre-Tax Benefit environment
  • Understands and can work in a production environment in which performance is tied to operational metrics
  • Integrity and discretion to maintain confidentiality of member’s HIPAA data.
  • Strong analytical ability necessary to work, discover and outline systems related issues on own as well as within a team.
  • The ability to take the lead on projects and recommend and implement process to complete work.
  • Proficient in MS Excel and MS Word.

 

Finishing Touches (Preferred):

 

  • 4 year College degree or equivalent work experience

 

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

 

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