Eligibility and Enrollment Analyst (State Based Exchange)

Under supervision, the Eligibility and Enrollment Analyst is responsible for reviewing and updating program policies and operational procedures.

Analyze customer issues to determine causes and develop new processes, document changes, and new steps as developed.

Monitor assigned health and/or dental carrier ticketing trends and work with carriers to resolve consumer eligibility and enrollment escalations and address issues.

Review and update consumer eligibility, verification, and appeals policies.

Support and participate in the annual federal programmatic audit and any other audits, as needed.

Analyze monthly enrollment discrepancy reports for assigned health and/or dental carriers.

Review, respond and/or resolve escalated Contact Center inquiries and appeals reported by consumers, agents, and private-sector partners.

Partner with assigned carrier(s) and internal team members to resolve issues identified in the monthly enrollment reconciliation files to ensure accuracy of consumer accounts.

Coordinate with the agency’s Administrative Procedures department for eligibility appeals.

Coordinate with other state agencies as necessary, such as the Department of Human Services (DHS) and Department of Community Health (DCH), for referrals of consumers to/from Medicaid and Georgia Access.

Performs other duties assigned.