Lead Enrollment Analyst

Network Health's success is rooted in its mission to enhance the life, health and wellness of the people we serve. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Lead Enrollment Analyst.

The Lead Enrollment Analyst is responsible for managing all enrollment and disenrollment activities, as well as reconciliation and related analytical tasks. This role requires an independent, critical thinker with a technical mindset and strong understanding of eligibility data. The analyst will work closely with both internal and external stakeholders to prioritize daily tasks and projects, while also identifying opportunities for process improvement.

In addition, this role supports the interpretation and implementation of enrollment-related changes from the Department of Health Services (DHS), as applicable. The Lead Enrollment Analyst plays a key role in providing analytical and data management support, ensuring timely processing of transactions, and maintaining compliance with all state and federal regulations. As a subject matter expert, the Lead Enrollment Analyst also assists in resolving complex issues and performs core departmental responsibilities.

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Essential Job Duties:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies
• Process enrollment applications, changes and terminations for all products received
• Provides accurate, timely reporting per department, regulatory and/or business requirements
• Develops, maintains and regularly reviews department policies, processes and desk procedures to ensure regulatory compliance, maximum efficiencies, and alignment with industry best practice; identifies gaps and works with department leadership and/or trainers to facilitate implementation of improved processes.
• Review on a regular basis federal regulations, state mandates, legislative changes, and legal requirements for enrollment processing, eligibility and requirements. Assure that policies and procedures, documentation, and communications are such that risk of legal action is minimized. Communicate findings to peers, recommend and implement best practices.
• Performs audits per department standard and works with department leadership as well as appropriate internal and/or external stakeholders to identify root cause analysis and develop corrective action plans as necessary
• Assist in regulatory and compliance reporting as required by industry standards and governing bodies
• Interpret data, identify trends, establish/utilize benchmark data, and present information in clear, concise, and useful formats, including data visualizations and interpretation of information
• Document processes used in transforming raw data to meaningful information. This will provide the stakeholder with a fully defined report, an analysis of the results, and the process used to create the information
• Acts as subject matter expert assisting in resolution of complex issues
• Advises department leadership of concerns including process issues, need for additional resources and associate training needs.
• Provide training to team or individuals as necessary
• Other duties as assigned
  
  

Position Requirements:

• Associate Degree or 4 years of directly related work experience required
• 3 years of directly related work experience
• Customer Service, Enrollment and Claims services experience strongly preferred
• Health insurance experience preferred

Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.