Enrollment Integrity Analyst

South Florida Community Care Network Llc; Town of Florida (NY); On-site; USD 60,174,000 - 71,635,000; Full time

Job summary

South Florida Community Care Network Llc in Sunrise, FL is seeking an Eligibility & Enrollment Analyst to ensure accuracy of member enrollment and eligibility across Medicaid, Marketplace, CHIP and Commercial plans. This role updates the health plan operating system and supports regulatory requirements.

The position requires collaboration with internal teams and external vendors to resolve enrollment issues, perform reconciliations, and ensure clean data for downstream processes.

Qualifications

• Strong understanding of health insurance eligibility rules, enrollment transactions, and reconciliation processes.
• Familiarity with CMS, state Medicaid, and Marketplace enrollment guidelines.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and ability to navigate multiple systems.

Responsibilities

• Monitors and processes daily CRM and workflow requests to update member eligibility, demographics, and third-party liability coverage.
• Accurately enters, updates, and maintains enrollment information in health plan systems.
• Processes Marketplace enrollment transactions, including plan changes, reactivations, coverage terminations, and life event updates.
• Coordinates with Marketplace Exchange platforms and state agencies to resolve enrollment discrepancies.
• Conducts periodic audits of eligibility data and initiates corrections for regulatory compliance.
• CCP liaison to outside customers and clients, such as pharmacy benefit managers and client HR representatives, to resolve urgent eligibility issues.
• Performs monthly and ad-hoc reconciliation between internal systems, Marketplace enrollment files, Medicaid eligibility feeds, and vendor rosters.
• Identifies and resolves data mismatches that could impact member benefits, provider payments, or vendor fulfillment.
• Coordinates eligibility file cleanup to ensure proper head-of-household assignment for Medicaid flex card distribution.
• Escalates recurring or systemic issues to the Supervisor for resolution planning.
• Responds to inbound calls from members regarding enrollment status, demographic changes and premium billing inquiries.
• Acts as a liaison to external vendors, state agencies, and Marketplace partners for urgent eligibility and enrollment issues.
• Provides timely responses to internal inquiries from CS, Claims, and other teams.
• Assists members with eligibility-related questions when required.
• Participates in special projects, testing, or system updates related to enrollment processes.
• Supports QA reviews and maintains audits/compliance documentation.
• Performs other related duties as assigned.

Skills

Health insurance rules

Enrollment transactions

Reconciliation processes

CMS/Medicaid/Marketplace guidelines

MS Office proficiency

Attention to data accuracy

Verbal and written communication

Multi-tasking

Analytical problem solving

Independent and collaborative work

Education

High school diploma or equivalent

Associate or bachelor's in business/healthcare admin

Tools

Epic/Tapestry

Softheon

Job description

South Florida Community Care Network Llc in Sunrise, FL is seeking an Eligibility & Enrollment Analyst to ensure accuracy of member enrollment and eligibility across Medicaid, Marketplace, CHIP and Commercial plans. This role updates the health plan operating system and supports regulatory requirements.

The position requires collaboration with internal teams and external vendors to resolve enrollment issues, perform reconciliations, and ensure clean data for downstream processes.