Project Role : Custom Software Engineer
Project Role Description : Develop custom software solutions to design, code, and enhance components across systems or applications. Use modern frameworks and agile practices to deliver scalable, high-performing solutions tailored to specific business needs.
Must have skills : Health Insurance Operations
Good to have skills : Electronic Data Interchange (EDI), Payer Eligibility & Enrollment, HealthEdge
Minimum 12 year(s) of experience is required
Educational Qualification : 15 years full time education

Summary:
Accenture is seeking an experienced Health Payer Operations professional with strong expertise in HealthEdge, EDI transactions, and Member Enrollment processes. The candidate will be responsible for supporting payer operations, managing member enrollment and eligibility activities, analyzing healthcare data, and ensuring compliance with healthcare industry standards. The role requires strong knowledge of U.S. healthcare payer operations and the ability to collaborate with cross-functional teams to deliver high-quality outcomes.

Key Responsibilities
Manage end-to-end member enrollment and maintenance activities in HealthEdge platforms.
Process and validate member eligibility, enrollment, and benefits data.
Perform analysis and resolution of enrollment-related issues and discrepancies.
Work on EDI transactions including 834 Member Enrollment and associated healthcare data exchanges.
Monitor inbound and outbound EDI files and ensure timely processing.
Conduct data validation, reconciliation, and quality assurance activities.
Collaborate with business, operations, and technical teams to resolve production issues.
Support process improvement initiatives to enhance operational efficiency and accuracy.
Ensure compliance with HIPAA and healthcare payer regulations.
Create operational reports, dashboards, and status updates for stakeholders.
Participate in requirement gathering, testing, and implementation activities related to HealthEdge enhancements.
Professional & Technical Skills
Must Have
Strong experience in HealthEdge platform.
Experience in Health Payer Operations.
Knowledge of EDI transactions, especially 834 Member Enrollment.
Experience in Member Enrollment and Eligibility processes.
Understanding of U.S. Healthcare Payer business processes.
Knowledge of HIPAA regulations and healthcare data standards.
Strong analytical and problem-solving skills.
Good to Have
Experience with Claims, Benefits Configuration, or Provider Data Management.
Knowledge of Facets, QNXT, or other healthcare payer platforms.
Experience with SQL and data analysis.
Exposure to Agile delivery methodologies.
Working knowledge of healthcare reporting and operational metrics.
Educational Qualifications
Bachelor's Degree in Healthcare Administration, Business, Information Technology, or a related field.
Relevant HealthEdge or Healthcare Operations certifications are preferred.
Years of Experience
7 to 10 years of experience in Health Payer Operations, Member Enrollment, HealthEdge, and EDI processing.
Preferred Candidate Profile
Strong communication and stakeholder management skills.
Ability to work in a fast-paced operational environment.
Experience handling healthcare payer production support and operations.
Proven ability to manage multiple priorities and deliver quality outcomes.

15 years full time education

About Accenture

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities.

Visit us at www.accenture.com 

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