Billing Membership Analyst

The Billing Membership Analyst will support enrollment, eligibility, and premium billing operations while ensuring transactions are accurately processed and reconciled in accordance with regulatory and business requirements.

The role involves reviewing enrollment files, researching discrepancies, processing transactions, supporting members/providers, and working with internal teams and third-party vendors to resolve eligibility and billing issues.

Key Responsibilities

• Process, implement, and reconcile enrollment, eligibility, and billing transactions.
• Review enrollment files and resolve system errors and rejected transactions.
• Investigate transactions rejected by Client, FFM, and other third-party vendors.
• Perform quality-control audits and reconciliation of enrollment files.
• Analyze data from multiple sources to identify discrepancies and compliance risks.
• Research and maintain knowledge of regulations affecting enrollment, eligibility, and premium billing.
• Respond to member, provider, employer, and broker inquiries regarding eligibility and billing.
• Handle incoming calls on the Group/Broker support line and document inquiries appropriately.
• Perform outreach to prospective enrollees or employer groups to verify enrollment information.
• Assist with correspondence processing and document-management activities.
• Develop and maintain procedures that support accurate and compliant eligibility and billing operations.
• Work independently while collaborating effectively with team members.
• Maintain strict confidentiality of member health and business information.

Minimum Qualifications

• High school diploma or equivalent required.
• At least 1 year of experience in eligibility processing, record/report auditing, data processing, customer service, claims, or healthcare eligibility systems.
• Experience with healthcare claims, enrollment, eligibility, or billing systems preferred.
• Basic Microsoft Office skills, including Word, Excel, and Access.
• Typing speed of approximately 35 WPM with 95% accuracy.
• Strong analytical, troubleshooting, and proofreading skills.
• Excellent attention to detail.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Ability to exercise independent judgment and solve problems.
• Professional communication skills when interacting with customers, providers, brokers, and leadership.

Work Requirements

• Fully onsite in Akron, OH.
• Monday–Friday, 8:00 AM–5:00 PM.
• No weekends.
• Candidates should be local to the Akron/Canton area.
• Teams interview required.
• Please provide candidate availability for the interview when submitting.
• Must be able to start ASAP.

Ideal Candidate

The ideal candidate will have experience in healthcare eligibility, enrollment, claims, billing, or member services, with strong attention to detail and the ability to analyze and resolve complex data discrepancies.

 At Encode, we believe that our employees are our greatest asset, and we are committed to fostering a supportive and inclusive work environment. We offer a comprehensive benefits package that includes health insurance, retirement plans, and generous paid time off. Our flexible work arrangements and emphasis on work-life balance ensure that our employees can achieve their professional goals while maintaining a healthy personal life. Additionally, we provide opportunities for continuous learning and career advancement, including professional development programs and access to cutting-edge technologies.

As a cleared facility, we have a particular need for individuals with active Secret or Top Secret clearances. Your expertise and security clearance would be invaluable in supporting our mission-critical projects and ensuring the highest standards of security and compliance.

We would love to discuss how your experience and skills align with our needs and explore potential opportunities with Encode. If you are interested in learning more, please reply to this email with your updated resume and a convenient time for a brief conversation.

Thank you for considering this opportunity. We look forward to the possibility of working together and contributing to your professional journey.