Sr. Ops Eligibility/Accums Analyst

• Drive the end-to-end process of eligibility file transfers, ensuring seamless and efficient data exchanges between internal systems and external partners.
• Lead cross-functional initiatives to enhance data integration, mapping accuracy, and overall system performance.
• Design and implement advanced eligibility file processes to streamline operations and reduce error rates.
• Identify opportunities for automation and process improvements, leveraging cutting-edge tools and methodologies.
• Oversee the mapping, transformation, and integration of complex file types, including 834, XML, fixed width, delimited, and proprietary formats.
• Serve as the subject matter expert for troubleshooting advanced data exchange issues, ensuring timely resolution.
• Evaluate and recommend tools and technologies to improve eligibility file processing and data integrity.
• Partner with internal teams, clients, and external vendors to define and maintain eligibility file specifications, transmission protocols, and data requirements.
• Build and maintain strong relationships with key stakeholders to ensure the timely resolution of issues and continuous improvement of processes.
• Provide mentorship and technical guidance to junior analysts and specialists, fostering a culture of learning and growth within the team.
• Lead training sessions to enhance team competencies in data mapping, file integration, and error resolution.
• Ensure adherence to Client’s privacy and security standards, including compliance with HIPAA and other relevant regulations.
• Develop and maintain comprehensive documentation of processes, ensuring transparency and accountability.

Required:

• Minimum of 10+ years of experience in eligibility management, data integration, or a similar field.
• Hands-on experience with file transmission protocols (e.g., FTP/Secure FTP, VPN) and automation tools.
• Mastery of data transformation and validation logic.
• Expert-level knowledge of eligibility file formats, data mapping, and systems integration.
• Extensive experience working with file formats such as 834, XML, and proprietary eligibility data formats.
• Proven expertise in SQL, data mapping, troubleshooting complex file transmission issues, advanced querying, and data analysis.
• Familiarity with PBM claims adjudication processes and healthcare data standards.
• Advanced proficiency in Excel, including using macros, pivot tables, and complex formulas.
• Proven track record of leading complex projects with multiple stakeholders.
• Exceptional analytical and problem-solving skills to address high-level challenges and implement sustainable solutions.
• Excellent written and verbal communication skills to effectively interact with senior leaders, clients, and vendors.

Desired:

• Certification in project management (e.g., PMP, Six Sigma) or process improvement.

Education:

• Bachelor’s degree in Business, Information Systems, Data Analytics, or a related field. (Master’s degree preferred)

GalaxE, now Endava, is a professional IT services firm that specializes in platform-driven solutions and the use of automation to achieve enterprise business transformation and mission-critical change for some of the largest companies in the world. Using our proprietary solution set, GxFource®, we apply machine learning techniques and predictive analytics tools as part of a broad artificial intelligence strategy that provides effective impact and data-driven business transformation. 

Since its founding, GalaxE has been dedicated to advancing the benefits of technology. Recently, we have joined forces with Endava, to offer our employees global exposure and enhanced opportunities. As we continue that legacy and look to the future, a focus on business enablement through agile, cost-efficient, and effective integration of people, process, and technology anchors our success. We revolutionize change in the costs of doing business that transform companies and their ability to leap beyond the competition.

We value people and are committed to diversity and inclusion where our employees are made to feel comfortable and are encouraged to be authentic.

We are always looking for passionate, entrepreneurial-minded innovators and disrupters; game-changers that take ownership of the work they produce and bring it each and every day. Working with like-minded team members you will get a chance to discover, develop, and use cutting-edge technologies to transform the way we deliver creative business solutions.

Sound like you? Join us and find out for yourself what it means for you, and your career, to be part of the GalaxE team. Let’s build something, together.

*Equal Opportunity Employer/Veterans/Disabled

** Pay is based on several factors including market location and may vary depending on actual job-related knowledge, skills, and experience.

Physical Requirements:

• Prolonged periods of remaining stationary at a desk and working on a computer
• Must be able to lift to 15 lbs., as needed
• Must be able to work on-site (corporate/client offices), as needed (not applicable for 100% remote roles)
• Occasionally required to bend, kneel, crouch, and reach overhead.
• Hand-eye coordination necessary to operate computers and various pieces of office equipment. 
• Specific vision abilities required include close vision, the ability to tolerate fluorescent lighting, and the ability to adjust focus.

Employees must be able to perform the physical requirements of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees requiring accommodations to perform the essential functions of their jobs, absent undue hardship.

For more information, please visit https://info.endava.com/galaxe-has-joined-endava