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The Electronic Eligibility Support Analyst is responsible for the set up and loading of electronic eligibility files. This position is responsible for the overall electronic eligibility process using various databases and / or checklists. You may research electronic eligibility issues and develop customer specific resolutions. This also may include auditing electronic eligibility file loads for adherence to quality measures and reporting standards.
- Handling Electronic Eligibility Files and supporting the UMR Enrollment System
- Loading and support of all eligibility files for new and existing UMR customers.
- Work directly with external and internal customers including vendors
- Handles outgoing eligibility files for ID card, pharmacy vendors, internal products/systems, and other vendors
- Responsible for analyzing system, manual, and workflow processes and making appropriate recommendations for improvement
- Manage improvement from recommendation to completion, by creating specifications, test plans, working with the IT area, testing, production review and implementing new procedures or training materials
- This position supports the Enrollment System and all projects supporting this system, which include: mandates as well as the HIPAA 834 and 270/271 transactions
- Installation of electronic eligibility for assigned accounts, including, but not limited to: file set up and testing, checklist/database updates, file revisions, researching and resolving file issues, and preparation of procedures or training materials.
- May research electronic eligibility issues and develop customer specific resolutions
- May include auditing electronic eligibility tasks and processes for adherence to quality measures and reporting standards
- Analyzes and investigates electronic eligibility processes and procedures
- Provides explanations and interpretations within area of expertise
- High School Diploma / GED (or higher)
- Experience working on process improvement projects / teams
- Ability to work Monday - Friday, 8:00 am - 5:00 pm, flexible hours with overtime on weekends and throughout the week
- Ability to travel less than 25% of the time
- 1+ years of experience with business analysis
- Experience in the healthcare insurance industry
- Experience acting as a liaison between business and IT teams
- Experience writing and executing test plans in either a QA or UAT capacity
- Project coordination experience
- Experience with DB2 and / or Mainframe
- Knowledge of project methodologies - being able to manage small projects
- Experience working with programming in web based application and / or databases
Physical Requirements and Work Environment:
- Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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Process Improvements (Business)