Member Enrollment Analyst

Member Enrollment Analyst, Denta Quest

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners, and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop‑loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Location:

Sun Life embraces a hybrid work model that balances in‑office collaboration with the flexibility of virtual work. Our team members and leaders are expected to be present in the office at least 2 days per week.

The Member Enrollment Analyst (MEA) is a leader; accountable for the coordination, implementation, and training of all processes related to eligibility EDI 834. This role has a general knowledge of all clients’ electronic enrollment (EE) files to prioritize and coordinate the running of EE files. Handles high‑profile, critical client implementations from onset to implementation, and ensures membership accuracy within the system.

The MEA will exhibit the highest level of knowledge of the EE process and membership data, and assist in the reconciliation of the claims system’s membership data to our financial system.

• Document client‑specific eligibility business rules using tools such as Word, Visio and Excel; communicate business rules to IT.
• Discern and utilize the IT applications and tools used to aid data mapping, business rules, and HIPAA compliance; work with IT to implement technical aspects of system and data configurations based on business rules.
• Manage new eligibility EDI electronic enrollment (EE) implementations and changes to existing clients’ EE files through conference calls, e‑mails, on‑site visits, and ongoing customer communication.
• Author and maintain HIPAA 834 and Proprietary Companion Guides that enable clients to comply with processing requirements and reduce errors.
• Manage a high volume of projects and tasks with different priorities.
• Facilitate team meetings to share information related to membership and EE; ensure issues are communicated and understood by the team.
• Develop and maintain comprehensive schedules related to the status of new EE business; communicate regular statuses to Client Engagement, Sales, and other impacted departments.
• Perform monthly membership data reconciliation utilizing the HIPAA 834 EDI files; work closely with Client Engagement to review and communicate results.
• Partner with IT to implement new requirements; define requirements, approve Use Cases, perform user acceptance test (UAT), and approve code fixes into production.
• Prioritize EE files; work with supervisor to coordinate resources to accommodate the timely processing of files and meet or exceed service levels.
• Design, develop, and execute SQL queries to identify root cause where problems exist within membership data.
• Provide excellent customer service by responding to membership‑related inquiries in a timely and accurate manner; may require extensive research with diverse resources.
• Establish and maintain membership data via EE files; manage timely and accurate processing of files to ensure all systems have correct data.
• Identify EDI solutions to business needs and constantly improve the effectiveness of our communications as they relate to eligibility and membership.
• Proactively communicate and coordinate eligibility issues with Sales, Client Engagement, and Customer Service and impacted departments; work collaboratively with these departments to develop solutions.
• Maintain company goals by participating on and providing eligibility EDI expertise to departmental and company projects.
• Assist clients in the interpretation and management of membership and eligibility reports.

• Bachelor’s degree and related EDI or Business Analyst experience.
• Minimum 3 years of technical experience, preferably with EDI.
• In depth knowledge of EDI Healthcare‑related file formats, including HIPAA 834, required.
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