Data Analyst II
1199SEIU Family of Funds - New York, NY

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Responsibilities
  • Review, monitor, and analyze eligibility systemic data reports, vendor export files, and pre-edit reports for active working members, dependents, and retirees/spouses to ensure data integrity
  • Review and assist in maintaining, monitoring, and performing enrollment, disenrollment, CMS rejections, HIP, Humana, Medicare Part D, EGWP, and Medco to maintain member eligibility
  • Provide weekly review of Medco Pre-Edit reports and other external vendor files
  • Review and monitor daily Eligibility Control reports and Eligibility Nightly Batch to ensure members are not incorrectly downgraded, suspended/terminated, and to report system discrepancies and anomalies
  • Develop business test cases for testing system logic changes and program modifications to ensure logic is operating according to business guidelines and design specifications
  • Maintain Eligibility System (Vitech) Benefit Plan tables, Retiree Plan tables, Medco Factor tables, etc. to ensure eligibility system is calculating and updating correct benefit plan, etc.
  • Create data comparison analysis, reconciliation, review, and monitor systematic data reports to ensure the quality and integrity of the eligibility/enrollment data and evaluate results and report findings with recommendation for corrective action
  • Respond in a timely manner to the eligibility system and external vendor system/files for member inquiries (internal and external) via email, phone, and/or hard copies
  • Perform additional duties and projects as assigned by management
Qualifications
  • Bachelor’s degree or equivalent years of work experience required; plus
  • Minimum of four (4) years experience in data analysis (gathering and analyzing data for problems and issues)
  • Demonstrated experience in analysis, interpretation & reporting using large-scale health data sets
  • Basic level of proficiency in PL/SQL required; Intermediate level is MS Excel and Word.
  • Experience with requirements gathering and assisting business units to develop applications (dashboards and scorecards) to monitor measures, metrics and KPI’s
  • Experience with healthcare enrollment, eligibility, health coverage, Coordination of Benefits (COB), or Consolidated Omnibus Budget Reconciliation Act (COBRA) in a health insurance or benefits environment a plus
  • Strong Interpersonal skills with attention to detail and accuracy; ability to interact and communicate well with all levels of staff
  • Ability to work well in a team environment, meet tight deadlines and handle several projects simultaneously
  • Available to work evenings and weekends as needed
  • Must meet performance standards including attendance and punctuality

1199SEIU Family of Funds - 22 months ago - save job - block
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