Eligibility, Enrollment & Reporting Specialist - CommUnityCare : Job Details

Overview

The Eligibility, Enrollment & Reporting Specialist is responsible for managing member enrollment processes, ensuring data integrity, and generating accurate reporting to support operational and regulatory needs. This role requires hands-on experience with health plan claims systems, preferably VBA, and the ability to extract and analyze data from the organizations data warehouse. The ideal candidate will be detail-oriented, collaborative, and comfortable working in a fast-paced environment to support both internal stakeholders and external compliance requirements. The position reports to the VP of Data Management and Analytics.

Essential Functions:Eligibility, Enrollment & Data Management: Maintain accurate eligibility and enrollment data across ACA and ERISA markets. Monitor and reconcile eligibility, enrollment files from external partners (e.g., exchanges, employer groups, thirdpartyadministrators). Support implementation and maintenance of enrollment workflows in the VBA claims system.Reporting & Analytics: Build workflows/reports for eligibility exceptions and urgently and effectively report and manage these issues. Pull and analyze data from the data warehouse to produce operational, regulatory, and ad hoc reports. Collaborate with cross-functional teams to ensure data accuracy and consistency. Develop and maintain documentation of reporting processes and data flows.Systems & Process Support: Serve as a subject matter expert for enrollment and reporting functionality within the claims system. Assist in system testing for new releases, enhancements, or changes to enrollment and reporting processes. Identify and escalate data or system issues to appropriate technical teams for resolution.Collaboration & Communication: Partner with internal teams (Claims, Finance, Compliance, and Operations) to support decision-making and process improvements. Provide timely updates to leadership regarding trends, issues, and opportunities for improvement. Act as a team player, supporting departmental goals and assisting colleagues as needed

Knowledge, Skills and Abilities:

Strong understanding of ACA and ERISA health plan requirements.

Excellent problem-solving skills and attention to detail. Ability to work collaboratively across departments. Knowledge of HIPAA regulations and data privacy requirements. Familiarity with process improvement methodologies. Analytical Thinking & Data Accuracy. Technical Aptitude & Systems Knowledge. Collaboration & Communication. Adaptability in a dynamic regulatory environment.

Minimum Education:

• Bachelor's Degree (higher degree accepted) In Information Systems, Healthcare Administration, or a related field, or equivalent work experience.

Minimum Experience: (5 years)

• Experience in enrollment, reporting, or data management within a health plan environment.
• Experience with claims systems, preferably VBA.
• Proficiency in pulling and analyzing data from a data warehouse (SQL or similar tools).