Enrollment Data Analyst

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Evry Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2017

⚕️ Healthcare Insurance

🤝 B2B

🧘 Wellness

Healthcare Insurance • B2B • Wellness

Evry Health is a modern, mobile-first health insurance company that provides fully insured employer health plans and personalized care teams. Built for midsize and larger employers (primarily in Texas), Evry offers no-copay, no-deductible plans, 24/7 virtual care, integrated wellness programs, and individualized support from nurses, nutritionists, and doctors to simplify costs and improve employee health. The company emphasizes a human, member-focused approach and digital tools (iOS/Android app) to deliver care and benefits.

📋 Description

• 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

🎯 Requirements

• 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.

🏖️ Benefits

• Must maintain a dedicated, private workspace that is separate from other living areas and supports the secure handling of confidential information. • Must have a reliable high-speed internet connection. • All company-sensitive documents must be kept secure and handled in accordance with Evry Health data privacy and security policies.