Healthcare Enrollment Gatekeeper & Data Analyst

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 55,000 - 75,000; Full time

Job summary

Independence Blue Cross in Philadelphia seeks an Enrollment Operations Specialist to support member enrollment flows and reconcile CMS transactions. You will coordinate manual enrollment updates, review 834/820 files, and ensure data accuracy across Health Rules/Proof and mPulse gateways.

Ideal candidates have 2–3 years in healthcare, solid understanding of ACA consumer business, and strong communication skills to interface with internal and external customers.

Qualifications

• BA/BS in business-related field or equivalent experience.
• 2–3 years in healthcare.
• Knowledge of ACA Consumer business and CMS basics.

Responsibilities

• Update manual enrollment transactions in Health Rules/Proof.
• Review CMS files (834, 820, pre-audit) to improve processes.
• Manage inbound/outbound electronic files via Gateways.
• Analyze enrollment fallout and coordinate updates in systems.
• Follow productivity and quality goals.
• Escalate trends to management.
• Participate in ad-hoc projects.

Skills

Enrollment coordination

EDI & enrollment systems

XML/ANSI 834

Communication

Data processing

Microsoft Office

SharePoint / SNOW

Education

BA/BS in business-related field

Tools

Health Rules/Proof

One Hub

SNOW

SharePoint

Job description

Independence Blue Cross in Philadelphia seeks an Enrollment Operations Specialist to support member enrollment flows and reconcile CMS transactions. You will coordinate manual enrollment updates, review 834/820 files, and ensure data accuracy across Health Rules/Proof and mPulse gateways.

Ideal candidates have 2–3 years in healthcare, solid understanding of ACA consumer business, and strong communication skills to interface with internal and external customers.