Note: The job is a remote job and is open to candidates in USA. Evry Health is on a mission to bring humanity to health insurance, and they are seeking a detail-oriented Enrollment Data Analyst to support the accuracy and integrity of member enrollment data across their health plan systems. This role involves managing the lifecycle of enrollment data, ensuring compliance with standards, and collaborating with various teams to resolve data issues.

Responsibilities

• Configure, monitor, and troubleshoot inbound and outbound HIPAA 834 (Benefit Enrollment and Maintenance) transaction files with trading partners, employers, and TPAs
• Validate 834 file structures for compliance with X12 5010 standards, identifying and resolving segment errors, loop discrepancies, and rejected transactions
• Coordinate with trading partners to resolve enrollment exchange issues and ensure timely, accurate file transmission
• Perform systematic validation of member enrollment records against source documents, 834 transactions, and plan eligibility rules
• Identify data anomalies, duplicate records, coverage gaps, and demographic inconsistencies
• Execute data quality audits on a scheduled and ad-hoc basis, documenting findings and remediation steps
• Ensure enrollment data aligns with plan effective dates, benefit periods, and group contract terms
• Accurately enter and update member demographic, eligibility, and coverage data across the web UI enrollment portal and the claims processing system
• Process member adds, terminations, changes, and reinstatements in a timely manner in compliance with CMS and ACA guidelines
• Maintain supporting documentation for all manual data changes per audit and compliance standards
• Lead targeted data cleanup projects to address backlogs, legacy migration issues, and discrepancies identified through audits or operational escalations
• Write and execute SQL queries against enrollment and member databases to identify, extract, and correct data issues
• Collaborate with the engineering team on bulk update scripts and data remediation workflows
• Partner with engineering, claims, and population health teams to surface enrollment data issues affecting downstream claim adjudication, reporting, and care management workflows
• Support compliance and reporting requirements including ACA 1095-B and CMS enrollment submissions
• Communicate enrollment discrepancies and resolution status to internal stakeholders and external partners

Skills

• 2+ years of experience in health plan enrollment operations, managed care, or EDI data processing
• Hands-on experience with HIPAA 834 transaction processing and X12 EDI standards
• Proficiency with SQL-- able to write queries to retrieve, validate, and correct enrollment data directly against relational databases
• Experience working within claims administration systems (e.g., Plexis QC, QNXT, TriZetto, HealthEdge, or similar)
• Strong attention to detail with a proven ability to manage high volumes of data accurately
• Familiarity with ACA eligibility and enrollment rules, CMS guidelines, and HIPAA data privacy
• Experience with web-based enrollment portals or member engagement UIs
• Understanding of downstream impacts of enrollment data on claims adjudication and provider rosters
• Exposure to EDI mapping tools or translation software (e.g., Edifects, BizTalk, or Claritev)
• Familiarity with population health platforms or care management systems
• Experience supporting IRS Form 1095 or CMS risk adjustment data submissions

Company Overview