We're looking for a detail-driven Analyst to play a critical role in ensuring the accuracy, integrity, and timeliness of key data that powers member eligibility, billing, claims adjudication, and customer service delivery. In this role, you'll work cross-functionally to interpret complex information, manage sensitive data (including PHI compliance), and support operational excellence across enrollment, billing, and reporting systems. What You'll Do Data & Document Analysis Review and validate Enrollment Agreements, Change Agreements, and legal documents (e.g., BAA, TPA, confidentiality agreements) Interpret benefit structures, rate schedules, and eligibility rules Ensure accuracy and compliance with federal/state healthcare regulations System Accuracy & Data Management Maintain and update critical data in enterprise systems (e.g., GEMS or similar platforms)
Manage:
Coverage codes and financial coding Billing rates and administrative fees Member eligibility rules and group structures Ensure data integrity across claims processing, billing, ID card issuance, and reporting systems Operational & Financial Support Resolve rate discrepancies and benefits-related issues Support customer billing, enrollment processes, and claims operations Contribute to financial forecasting and reporting accuracy Stakeholder Collaboration Partner with internal teams (operations, underwriting, customer service, IT) Communicate effectively with internal and external stakeholders at all levels Facilitate or lead meetings to drive alignment and resolve issues Continuous Improvement & Compliance Stay current on healthcare regulations, compliance requirements, and product updates Identify opportunities to improve data accuracy, workflows, and operational efficiency Ensure compliance with PHI, HIPAA, and data governance standards Required Qualifications Experience in one or more areas: Healthcare operations, claims processing, enrollment, or billing Proven ability to: Analyze data, identify issues, and recommend solutions Manage multiple priorities with high attention to detail and accuracy Meet strict deadlines and performance metrics Strong communication skills: Ability to interpret complex information and explain clearly (written and verbal) Experience working with cross-functional teams and stakeholders Proficiency in: Microsoft Excel and Office Suite (data analysis, reporting) Preferred Qualifications Experience in: Healthcare insurance or payer environments Reviewing group files, benefit matrices, or legal agreements Underwriting or pricing analysis Familiarity with: Healthcare compliance (HIPAA, PHI handling) Enterprise systems such as GEMS or similar platforms About Seneca Resources At Seneca Resources, we are more than just a staffing and consulting firm, we are a trusted career partner. With offices across the U.S. and clients ranging from Fortune 500 companies to government organizations, we provide opportunities that help professionals grow their careers while making an impact. When you work with Seneca, you're choosing a company that invests in your success, celebrates your achievements, and connects you to meaningful work with leading organizations nationwide. We take the time to understand your goals and match you with roles that align with your skills and career path. Our consultants and contractors enjoy competitive pay, comprehensive health, dental, and vision coverage, 401(k) retirement plans, and the support of a dedicated team who will advocate for you every step of the way. Seneca Resources is proud to be an Equal Opportunity Employer, committed to fostering a diverse and inclusive workplace where all qualified individuals are encouraged to apply. Apply Now Share This Post
