Eligibility Analyst III

Job not on LinkedIn

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Liviniti

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2011

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Liviniti is a pass-through pharmacy benefit manager (PBM) that helps employers and health systems reduce prescription drug costs through transparent pricing, clinical programs, and drug sourcing. The company offers 100% rebate pass-through, a flat administrative fee, access to claims and rebate details for full visibility, customizable formularies and networks, prior authorization focused on lowest net cost, and specialized solutions like LivLite for managing GLP‑1 weight-loss drugs. Liviniti emphasizes B2B service, clinical value, and continuous innovation to lower pharmacy spend while maintaining member support and service.

📋 Description

• Execute and support complex eligibility work within established ownership • Serve as senior eligibility analyst, escalation support, and quality backstop for eligibility accuracy and production stability • Drive eligibility quality supporting claim adjudication • Maintain data integrity from upstream client eligibility through downstream eligibility shared with vendors and systems • Perform testing, monitoring, issue resolution, and escalations • Analyze and resolve complex eligibility issues impacting claims, accumulators, and member coverage • Support root cause analysis for recurring eligibility defects and data discrepancies • Provide escalation support for Analyst I/II eligibility issues • Partner with EDI, Implementation, Adjudication, and QA teams during testing and production support • Validate eligibility data across multiple systems and identify cross-functional impacts • Review eligibility outputs for accuracy and adherence to standards • Maintain and enhance eligibility documentation and processing standards • Maintain profiles on TPA/TPVs and ensure alignment with Liviniti strategies • Support audits and internal reviews related to eligibility accuracy • Monitor production trends and identify areas of risk or improvement • Ensure compliance with HIPAA, security, and Liviniti standards • Collaborate with clients, vendors, and internal stakeholders to onboard new eligibility feeds and enhancements • Identify opportunities for automation and process improvement within eligibility workflows • Report HIPAA violations to the Compliance Officer and/or Human Resources • Complete required HIPAA training and demonstrate competency • Informally mentor and support Analyst I/II roles • Guide the team on configuring and maintaining eligibility file mappings for inbound data feeds • Work across client time zones from the West to the East Coast • Minimal travel expected

🎯 Requirements

• Bachelor’s degree or equivalent experience • 5+ years of eligibility, EDI, or healthcare operations experience • Strong SQL & Excel skills • PBM or health plan experience strongly preferred • Experience supporting production EDI and Eligibility environments • Expert in EDI with a deep understanding of eligibility data structures and workflows • Strong analytical and problem-solving skills • Ability to work independently on complex issues • Strong judgment within defined processes and escalation paths • Clear written and verbal communication • Ability to manage multiple concurrent issues • Familiarity with eligibility impacts on claims adjudication and member benefits • Strong knowledge and working experience with transaction/file standards (270/271, 834, 835) • Ability to read, interpret, and troubleshoot raw X12 files • Knowledge of data integration and ETL tools • Strong data analysis skills (SQL, Excel, and other standard tools) • Working knowledge of relational SQL, No-SQL, warehouse, and cloud-based database technologies • Ability to translate technical findings into recommendations for cross-functional stakeholders • Experience with cloud data platforms such as Snowflake, AWS, or Azure • Experience with operational ticketing and workflow management systems such as Zendesk, JIRA, or Azure DevOps • Availability during core hours of 8:00 AM to 5:00 PM CT • Ability to work extended hours, weekends, and holidays in accordance with industry demands

🏖️ Benefits

• Medical, Dental, Vision insurance • Disability and Life insurance • Employee Assistance Program • Remote work options • Generous Paid-Time Off • Annual Reviews and Development Plans • Retirement Plan with company match immediately 100% vested