Analyst - Alegues File Integration

Overview

Perform carrier integration activities that support the successful transmission and maintenance of eligibility and enrolment data with external carrier partners, managing 834 EDI and non-834 carrier files.

What you'll do

• Monitor and manage daily inbound and outbound carrier eligibility file processing, including 834 EDI files and carrier-specific non-834 file formats, ensuring timely and accurate delivery.
• Analyze and resolve carrier file discrepancies, rejects, transmission failures, and enrollment exceptions to ensure data accuracy and successful processing.
• Perform validation and quality assurance checks on carrier files to identify and correct eligibility, demographic, and coverage data issues prior to transmission.
• Investigate and troubleshoot file-related issues raised by carriers, clients, and internal teams, coordinating resolution with appropriate stakeholders.
• Support implementation and maintenance of carrier file mappings, business rules, and file specifications for new and existing carrier integrations.
• Monitor and work on all incoming issues received through team mailboxes, ticketing systems, and service requests, ensuring timely resolution and escalation when required.
• Complete recurring operational tasks related to carrier file generation, transmission, reconciliation, and error resolution for assigned clients.
• Conduct file audits and reconciliations to identify potential enrollment discrepancies and ensure alignment between source systems and carrier records.
• Update and maintain carrier integration documentation, file layouts, process procedures, and testing results.
• Support testing activities for carrier changes, new implementations, system enhancements, and regulatory updates impacting carrier file exchanges.
• Identify process improvement opportunities and recommend automation or operational efficiencies related to carrier integrations and EDI file management.
• Support Team Lead by providing peer-to-peer guidance, knowledge sharing, and assistance with process updates and operational changes.
• Assist in training and mentoring new and existing team members on carrier integration processes, file specifications, troubleshooting techniques, and best practices.
• Build and maintain effective working relationships with carriers, implementation teams, operations teams, and technology partners to support successful file exchange operations.

What you'll need

• Must have knowledge of the US Health & Welfare (H&W) Benefits domain, including eligibility, enrollment, and carrier data exchange processes.
• Strong understanding of Carrier Integration processes, including 834 EDI transactions, carrier-specific non-834 file formats, eligibility file management, enrollment and termination processing, file reconciliation, and transmission monitoring.
• Experience in analyzing and resolving carrier file discrepancies, enrollment mismatches, file rejects, transmission failures, and data quality issues.
• Strong verbal and written communication skills with the ability to clearly communicate file-related issues, root causes, and resolution plans to internal and external stakeholders.
• Strong organizational and time management skills, including the ability to prioritize multiple tasks, manage competing deadlines, and support multiple carrier integrations simultaneously.
• Excellent analytical and problem-solving skills with the ability to investigate, troubleshoot, and resolve complex file integration and data exchange issues.
• Working knowledge of EDI standards, file layouts, data mapping, validation rules, and carrier-specific implementation requirements.
• Must have knowledge of carrier file configuration, file mapping, and file generation processes within Javelina.
• Must be familiar with employee demographic and enrolments data lookup, validation, and troubleshooting within Javelina.
• Experience performing data audits, reconciliations, and quality assurance reviews to ensure accuracy and completeness of carrier file transmissions.
• Ability to interpret carrier file specifications, business requirements, and operational procedures to support implementation and ongoing maintenance activities.
• Demonstrated ability to work independently as well as collaboratively within a team environment, while proactively identifying risks and driving issue resolution.
• Experience supporting testing activities for new carrier implementations, file changes, system enhancements, and production releases.
• Strong attention to detail with a focus on data integrity, compliance, and operational accuracy in a high-volume processing environment.
• 3.5+ years of experience in Benefits Administration, Carrier Integration, EDI processing, eligibility and enrollment administration, or operations support.
• Experience working with 834 EDI and non-834 carrier files, including file reconciliation, issue resolution, and data validation.
• Any graduate degree or equivalent qualification from a reputable institute.