Eligibility Operations Analyst

Position Summary:

Reporting directly to the Director of Eligibility Operations, the Eligibility Operations Analyst will serve as a lead Subject Matter Expert (SME) responsible for conducting and signing off on business validation of release test results;  establishing a methodology to conduct regular reviews of eligibility scenarios and data sets and, as needed, working with third party vendors and  other SMEs to determine next best steps to resolve any findings.  This position requires the ability to work collaboratively and cross-functionally internally and across multiple agencies, IT partners, and vendors to drive business objectives and fulfill responsibilities.

Responsible for:

  • Understanding CCA eligibility policy, federal and state regulations and how these should be executed in operations to achieve intended results.
  • Creation, development, and oversight of a methodology to routinely review Eligibility results against expected outcomes.
  • Development and oversight of a dashboard of activities and metrics which measure desired performance against actual results.
  • Lead a cross functional team whose charge is to routinely review this dashboard; analyze any discrepancies against expected outcomes and propose business solutions needed to resolve and continually improve overall performance.
  • Ensure end-to end business processes are documented and updated on a regular basis to reflect current state.
  • Participate in Joint Application Design (JAD) sessions involving cross functional teams, key business stakeholders and development managers.
  • Participate in HIX release business testing and ensure any changes to the HIX program as a result of releases produce the expected eligibility outcomes.
  • Log and monitor changes in functionality needed based on program review and findings.
  • As needed, create additional business scenarios for the UAT team to expand and improve release testing.

Experience and Qualifications:

  • A Bachelor’s degree is required; MPA, MPP, MPH, MBA, or other professional degree preferred
  • Experience in health care, insurance, regulatory interpretation, and/or government operations preferred
  • Vendor Management experience strongly preferred
  • Proven analytical and problem-solving skills
  • Exceptional MS Excel and PowerPoint skills and experience analyzing large datasets using MS Excel
  • Strong organizational, oral and written communication skills
  • Comfort in a fast-paced environment with competing priorities
  • Demonstrated ability to work collaboratively and effectively in a cross-functional environment
  • Self-starter who can work independently

Salary: Salary range is competitive; salary will be commensurate with experience.

Work Setting: This position requires the employee to work on-site in an open office setting.

Interested: Send cover letter and resume to

Please note: Due to the requirement of 268A, please complete the disclosure form and return with your application.

About the Health Connector: The Commonwealth Health Insurance Connector Authority (Health Connector) is an independent public authority serving as the Affordable Care Act (ACA)-compliant marketplace for the Commonwealth. The organization is charged with providing subsidized and unsubsidized health insurance to individuals and small employers. The Health Connector also oversees policy development related to health care reform under both state and federal laws, as well as conducting public education and outreach about health care reform and coverage opportunities.


The Health Connector is an equal opportunity employer that values diversity as a vital characteristic of its work force.  We consider qualified applicants without regard to race, color, religion, gender, sexual identity, national origin or disability.

Thursday, September 19th, 2019|