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Claims Analyst (Enrollment & EDI)

Lumen Solutions Group, Inc.

Baltimore, MD

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JOB DETAILS
SKILLS
Analysis Skills, Blueprints, Brokerage, Business Processes, Business Strategy, Card Processing, Communication Skills, Consulting, Cross-Functional, Data Analysis, Data Processing, Detail Oriented, Electronic Data Interchange (EDI), Enterprise Architecture, Functional Analysis, Health Insurance, Identify Issues, Information Technology Consulting, Microsoft Excel, Onboarding, Operational Support, Payment Processing, Pivot Tables, Problem Solving Skills, Process Management, Professional Services, Query Analysis, Reconciliation, Root Cause Analysis, Team Player, Technical Recruiting, Technical Support, Vlookups
LOCATION
Baltimore, MD
POSTED
30+ days ago
Company Description 
Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, and Enterprise Transformation. 
 

Role: Claims Analyst (Enrollment & EDI)
Location: Baltimore, MD (Remote)
Type: Contract-to-Hire (C2H)


Job Overview:

We are seeking a detail-oriented Functional Analyst to support enrollment operations within a healthcare insurance environment. This role will focus on onboarding vendors and brokers, managing enrollment processes, and supporting data exchanges related to ACA marketplace offerings, including ICHRA programs. The ideal candidate will have hands-on experience with EDI transactions, strong analytical skills, and proficiency in Excel.

Required Skills:

  • Bachelor’s Degree with 2+ years of relevant experience OR 6+ years of total experience without a degree.
  • Strong experience with EDI 834 transactions (enrollment files) – Required.
  • Experience in healthcare insurance domain, specifically enrollment operations.
  • Proficiency in Microsoft Excel (Pivot Tables, VLOOKUPs, data analysis, queries).
  • Experience working with enrollment and payment data files.
  • Strong analytical and problem-solving skills.
  • Excellent communication and collaboration abilities.

Key Responsibilities:

  • Support onboarding of vendors and brokers working with consumer direct enrollment teams.
  • Manage and process enrollment and payment files within internal systems.
  • Work with ACA marketplace offerings, including ICHRA (Individual Coverage HRA) programs.  
  • Analyze and troubleshoot issues related to enrollment, payments, and credit card transactions.
  • Perform root cause analysis for data discrepancies and operational issues.
  • Handle new employer group setups and collaborate with TPAs (Third Party Administrators).
  • Work with EDI transactions, specifically 834 enrollment files (MUST HAVE).
  • Support financial reconciliation processes, including payment files.
  • Utilize Excel for data analysis, including pivot tables, VLOOKUPs, and query handling.
  • Collaborate with cross-functional teams to ensure smooth enrollment operations.

Additional Requirements:

  • Experience with EDI 820 payment files (financial reconciliation).
  • Knowledge of group and individual enrollment processes.
  • Familiarity with Facets system.
  • Experience working with TPAs and vendor integrations.
  • Understanding of ACA marketplace and ICHRA programs.
   
Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status. 

About the Company

L

Lumen Solutions Group, Inc.

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