Eligibility Analyst III
Job Summary
Serving as the senior escalation support for eligibility accuracy, the full-time remote Eligibility Analyst III will manage complex eligibility issues, ensure data integrity, and collaborate with cross-functional teams to enhance eligibility workflows.
Key responsibilities
- Accountable for the quality of eligibility data driving claim adjudication and resolving complex eligibility issues
- Responsible for testing, monitoring, and issue resolution, while supporting audits and internal reviews related to eligibility accuracy
- Collaborate with EDI, Implementation, Adjudication, and QA teams to validate eligibility data and identify opportunities for process improvement
Required qualifications
- Bachelor's degree or equivalent experience
- 5+ years of eligibility, EDI, or healthcare operations experience
- Strong SQL and Excel skills
- Experience supporting production EDI and eligibility environments
- PBM or health plan experience strongly preferred
Complete Job Description
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