Healthcare Enrollment Gateway & Data Specialist

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

Job summary

Independence Blue Cross is seeking a healthcare enrollment analyst to support the Commercial Membership Operations workflow in Philadelphia. You will update manual enrollment transactions, review CMS files, and manage electronic file flows through Gateways and mPulse from multiple vendors and entities.

The role emphasizes processing accuracy, adherence to production targets, and collaboration with internal teams to resolve discrepancies and improve enrollment analytics.

Qualifications

• BA/BS degree in a business-related field or equivalent experience preferred.
• 2-3 years of experience in healthcare.
• Strong knowledge of EDI/enrollment systems; familiarity with XML/ANSI 834 HIPAA X12 transactions.

Responsibilities

• Update manual enrollment transactions in Health Rules/Proof.
• Review CMS files (834, 820, pre-audit, RCNI/Discrepancy) to develop best practices.
• Manage inbound/outbound electronic files via Gateway/mPulse from vendors/government entities.
• Analyze enrollment fallout/discrepancies and triage updates to Health Proof/CFI.
• Meet productivity and quality goals; communicate trends to management.
• Perform ad-hoc projects as requested.

Skills

Healthcare enrollment knowledge

Analytical thinking

Attention to detail

Effective communication

Education

BA/BS in Business-related field

Tools

Health Rules/Proof

One Hub

SNOW

SharePoint

EDI systems

XML/ANSI 834 HIPAA X12

Job description

Independence Blue Cross is seeking a healthcare enrollment analyst to support the Commercial Membership Operations workflow in Philadelphia. You will update manual enrollment transactions, review CMS files, and manage electronic file flows through Gateways and mPulse from multiple vendors and entities.

The role emphasizes processing accuracy, adherence to production targets, and collaboration with internal teams to resolve discrepancies and improve enrollment analytics.