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Sogeti · 1 day ago

Healthcare Enrollment Operations Analyst (AZ Remote)

United States

Full-time

Remote

Mid Level

Sogeti is part of the Capgemini Group, focusing on delivering innovative solutions through technology. The Enrollment Operations Analyst will manage and optimize enrollment data processing and reconciliation across various healthcare plans, ensuring high accuracy and efficiency in workflows.

ConsultingInformation TechnologyProfessional ServicesSoftware

No H1B

Responsibilities

Process daily inbound enrollment files containing adds, changes, and terminations

Validate successful file downloads in the enrollment correction platform

Review, analyze, and resolve data edits; apply corrections and reprocess files

Investigate items requiring secondary or multi‑round discovery when initial fixes do not resolve issues

Identify repetitive manual steps within daily processing workflows and implement automations (e.g., scripting, RPA, macros, rule‑based triggers) to reduce operational effort and defects

Load and review weekly inbound files for alternate plan types

Apply the same edit resolution and reprocessing workflow used in daily operations

Validate accuracy of migrated enrollment data and ensure it is processed correctly into downstream systems

Execute daily and monthly enrollment cycles for Medicare plan variations

Monitor automated ingestion of CMS response files into the eligibility platform

Load system-generated eligibility extracts into the enrollment correction tool, review edit queues and apply corrections

Identify opportunities to automate repetitive checks, data validations, or formatting steps through tools or scripts

Process periodic specialty program files, validating data quality and fixing missing or incorrect information

Ensure files successfully pass through correction and reprocessing cycles

Execute full‑file monthly data recon across all plan types

Compare downstream systems with source system data to identify discrepancies

Perform monthly 'true‑ups' by resolving differences and ensuring systems remain in sync

Automate recurring reconciliation steps where feasible (e.g., comparison logic, mismatch reports, summary dashboards)

Daily / weekly claims edits for re-processing after missed data, incorrect data, searching across other apps to resolve claims failing processing in system...and then reprocess

Qualification

Healthcare enrollment processingAutomation solutions designRPA tools experienceScripting languagesExcel automationData validationStakeholder managementProblem-solvingAttention to detailClear communication

Required

Experience with healthcare enrollment or eligibility file processing

Strong understanding of multi‑plan enrollment cycles, member adds/changes/terms, and downstream system dependencies

Proficiency with enrollment correction platforms and file reprocessing workflows

Ability to interpret edit codes, resolve root causes, and ensure accurate output

Ability to analyze manual operational steps and design automation solutions

Experience with one or more automation approaches: RPA tools (UiPath, Automation Anywhere, Power Automate), Scripting languages (Python, PowerShell), Excel automation (Power Query, VBA, macros), Automated file monitoring or rules-based processing

Ability to build, test, deploy, and maintain lightweight operational automations

Strong problem‑solving and multi‑pass investigation capabilities

Ability to manage high-volume edit queues accurately and efficiently

Strong attention to detail in reconciliation, data validation, and exception handling

Clear communication skills (verbal and written)

Ability to work independently under strict daily processing windows

Strong stakeholder management and proactive issue escalation skills

Preferred

Prior work with Medicare, Medicaid, commercial, or specialty plan enrollment

Experience reducing cycle time or defects through automation in operations environments

Exposure to legacy-to-modern platform migrations or large-scale data transitions

Benefits

Flexible work options

401(k) with 150% match up to 6%

Employee Share Ownership Plan

Medical, Prescription, Dental & Vision Insurance

Life Insurance

100% Company-Paid Mobile Phone Plan

3 Weeks PTO + 7 Paid Holidays

Paid Parental Leave

Adoption, Surrogacy & Cryopreservation Assistance

Subsidized Back-up Child/Elder Care & Tutoring

Career Planning & Coaching

$5,250 Tuition Reimbursement & 20,000+ Online Courses

Employee Resource Groups

Counseling & Support for Physical, Financial, Emotional & Spiritual Well-being

Disaster Relief Programs

Company

Sogeti

Glassdoor3.5

Part of the Capgemini Group, Sogeti makes business value through technology for organizations that need to implement innovation at speed and want a local partner with global scale.

Founded in 2007