Minimum 3 years of experience in eligibility, accumulators, claims, data operations, or production support
Bachelor's degree in Computer Science, Information Technology, Business, or a related field
Strong SQL proficiency (moderate to advanced) and proven data analysis and operational troubleshooting skills
Hands-on experience with eligibility and accumulator processing; knowledge of health insurance data, claims, and benefit structures; experience handling regulated data (HIPAA, PHI, PII, GDPR)
Requirements:
Provide technical support to customers, resolving product-related issues, troubleshooting defects, and managing escalations
Monitor inbound and outbound data exchanges, data quality, and processing to ensure operational accuracy
Execute and optimize SQL queries to retrieve, update, and manipulate data within relational databases
Collaborate with data, engineering, product, and operations teams to understand requirements, document workflows, and drive continuous process improvements and testing for new configurations and releases
Job description
100% Remote | 12‐Month Renewable Contract
Role Overview In this critical role, you will be responsible for triaging eligibility and accumulator operational issues and driving timely, high‐quality resolutions. You will serve as the first line of support, identifying root causes, attempting resolution, and escalating when necessary. You will manage a portfolio of clients and vendor partners, ensuring eligibility and accumulator data accuracy, performance, and compliance. The ideal candidate brings a hybrid background in technology and business, with strong expertise in eligibility, accumulators, benefit design, data analysis, and operational support within the health insurance domain.
The ideal candidate brings a prior Data Engineering background, including experience with data pipelines, data operations, and production support. Eligibility and accumulator experience is a major advantage, particularly within health insurance or claims‐based environments.
What You'll Do Data Processing & Analysis
Provide technical support to customers, resolving product‐related issues, troubleshooting defects, and managing escalations
Monitor file receipt, processing, and outbound data generation to ensure operational accuracy
Execute and optimize SQL queries to retrieve, update, and manipulate data within relational databases
Analyze large datasets to identify trends, anomalies, and root causes of issues
Recommend solutions and translate findings into actionable requirements for technical teams
Ensure all data is accurate, secure, and compliant with organizational standards and regulatory requirements (e.g., HIPAA, GDPR)
Monitoring & Issue Management
Monitor inbound and outbound data exchanges, data quality, and eligibility and accumulator performance for assigned clients and vendors
Proactively identify operational risks, recurring issues, and emerging trends
Perform detailed root cause analysis across large and complex datasets
Develop, document, and implement mitigation plans aligned with defined KPIs
Facilitate timely escalation of critical issues and ensure resolution follows established SLAs
Create clear documentation for workflows, analysis results, and processing procedures
Document, track, and maintain support cases in a ticketing or knowledge management system
Collaboration
Partner closely with data, engineering, product, and operations teams to understand requirements and deliver accurate solutions
Actively participate in team meetings and contribute ideas to improve processes, efficiency, and data quality
Continuous Improvement
Proactively design solutions to prevent recurring operational issues
Identify opportunities for system, process, and data improvements
Provide structured feedback to internal teams to support operational enhancements
Support testing activities for new configurations, enhancements, and releases
What You Need Required Qualifications
Minimum 3 years of experience in a related role (eligibility, accumulators, claims, data operations, or production support)
Bachelor's degree in Computer Science, Information Technology, Business, or a related field
Strong SQL proficiency (moderate to advanced)
Proven expertise in data analysis and operational troubleshooting
Hands‐on experience with eligibility and accumulator processing (required)
Knowledge of health insurance, pharmacy, medical and pharmacy claims, and benefit structures
Experience handling regulated data (HIPAA, PHI, PII, GDPR)
Strong analytical thinking, problem‐solving, and root cause analysis skills
Excellent attention to detail with a focus on accuracy and data quality
Strong communication and collaboration skills
Ability to manage multiple priorities independently in a remote environment
Preferred Qualifications
Experience with claims and insurance data (highly preferred)
Background in data engineering concepts (data flows, monitoring, troubleshooting, file exchanges)
Experience using Databricks, Python notebooks, and PySpark for analysis
Familiarity with Azure DevOps (ADO) or similar ticketing/work management tools
Understanding of APIs and data exchange processes
Prior experience in the Health Insurance industry (required for this role)
