The Eligibility, Enrollment & Reporting Specialist is responsible for managing member enrollment processes, ensuring data integrity, and generating accurate reporting to support operational and regulatory needs. This role requires hands-on experience with health plan claims systems, preferably VBA, and the ability to extract and analyze data from the organization’s data warehouse. The ideal candidate will be detail-oriented, collaborative, and comfortable working in a fast-paced environment to support both internal stakeholders and external compliance requirements. The position reports to the VP of Data Management and Analytics.

Essential Functions:

Eligibility, Enrollment & Data Management:
· Maintain accurate eligibility and enrollment data across ACA and ERISA markets.
· Monitor and reconcile eligibility, enrollment files from external partners (e.g., exchanges, employer groups, thirdparty
administrators).
· Support implementation and maintenance of enrollment workflows in the VBA claims system.

Reporting & Analytics:
· Build workflows/reports for eligibility exceptions and urgently and effectively report and manage these issues.
· Pull and analyze data from the data warehouse to produce operational, regulatory, and ad hoc reports.
· Collaborate with cross-functional teams to ensure data accuracy and consistency.
· Develop and maintain documentation of reporting processes and data flows.

Systems & Process Support:
· Serve as a subject matter expert for enrollment and reporting functionality within the claims system.
· Assist in system testing for new releases, enhancements, or changes to enrollment and reporting processes.
· Identify and escalate data or system issues to appropriate technical teams for resolution.

Collaboration & Communication:
· Partner with internal teams (Claims, Finance, Compliance, and Operations) to support decision-making and process improvements.
· Provide timely updates to leadership regarding trends, issues, and opportunities for improvement.
· Act as a team player, supporting departmental goals and assisting colleagues as needed

Knowledge, Skills and Abilities:

• Strong understanding of ACA and ERISA health plan requirements.

•  Excellent problem-solving skills and attention to detail. 
•  Ability to work collaboratively across departments. 
•  Knowledge of HIPAA regulations and data privacy requirements. 
•  Familiarity with process improvement methodologies. 
•  Analytical Thinking & Data Accuracy. 
•  Technical Aptitude & Systems Knowledge. 
•  Collaboration & Communication. 
•  Adaptability in a dynamic regulatory environment.

Minimum Education:

• Bachelor's Degree (higher degree accepted) In Information Systems, Healthcare Administration, or a related field, or equivalent work experience.

Minimum Experience: (5 years)

• Experience in enrollment, reporting, or data management within a health plan environment.
• Experience with claims systems, preferably VBA.
• Proficiency in pulling and analyzing data from a data warehouse (SQL or similar tools).