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Evolent Health Senior Analyst, Healthcare Payer Enrollment Operations in Helana, Montana

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Why We’re Worth the Application:

  • We continue to grow year over year.

  • Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .

  • Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index making us a best place to work for LGBTQ+ equality.

  • Named to Parity.org’s 2020 list of the best companies for women to advance (https://www.evolenthealth.com/about-us/press-releases/8579/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2021) .

  • Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.

  • Published an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we’re building an equitable workplace.

What You’ll Be Doing:

What You’ll Be Doing:

  • Partner with IT and business stakeholders as well as external trading partners to successfully implement a mix of initiatives ranging from functional enhancements and continuous improvements

  • Define business requirements and acceptance criteria/test cases related to programs facilitated by the Centers for Medicare and Medicaid (CMS) and our Commercial partners

  • Act as a trading partner liaison with our client partners to foster communication between business/IT teams, developers and external stakeholders.

  • Identify, document and analyze discrepancies and anomalies within automated data reconciliation and disputed data

  • Develop a deep understanding of the business rules, and leverage that knowledge to improve processes, recommend solutions, enhance team performance, and drive progression of client objectives

  • Utilize a variety of software and platforms for statistical analysis and research concerning data

  • Create and standardize solutions and workflows

  • Perform business analysis of identified process and software gaps or inefficiencies and develop plans to fill those gaps for internal business processes and for external clients

  • Perform requirements review with external and internal stakeholders and obtain sign off from all required individuals

  • Identify and document system deficiencies and recommends solutions

The Experience You’ll Need (Required):

  • Must have a Bachelor’s degree preferably with a quantitative or healthcare major

  • Extensive knowledge in health insurance third party administrator concepts for commercial, federal and state government plans specifically supporting operational processes for enrollment and eligibility processing, member benefits, and EDI Interfaces

  • Must have experience with SQL (advanced/2-5 years) Microsoft Excel (advanced/2-5 years) and Medicare Advantage Implementation

  • Knowledge of the Affordable Care Act, HMO and managed care principles including Medicaid and Medicare regulation

  • Solid aptitude of compiling data from many sources and defining designs for enrollment to benefit plan configuration

  • Strong analytical capabilities to understand data sets to derive business conclusions while identifying anomalies based on business rules

  • Independent thinker with the ability to multitask and manage multiple projects with varying timelines

  • Willingness to develop and explore new approaches, adapt, and execute quickly and be comfortable with ambiguous project outlines

  • Exceptionally strong analytical abilities, with track record of identifying insights from quantitative and qualitative raw data in varied formats requiring manipulation

  • Excellent interpersonal, oral and written communication skills

  • Able to work independently and within a collaborative team environment with little guidance/supervision

Finishing Touches (Preferred):

  • 3-5+ years of IT and/or business experience in an HMO/PPO Claims, Medicaid, Medicare and/or managed care healthcare environment

  • Extensive experience with the System Design Life Cycle (SDLC)

  • Experience with EDI X12 structure and syntax rules; chiefly with 834 files

  • Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis

Technical Requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Compensation Range: The minimum salary for this position is $75,565, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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