The Role
Manage health payer operations, including member enrollment, eligibility, benefits data, and HealthEdge platform activities. Process and monitor EDI 834 transactions, validate and reconcile healthcare data, resolve production issues, and ensure HIPAA compliance. Collaborate with business and technical teams on requirements, testing, implementations, reporting, and process improvements. Support operational dashboards and stakeholder communications while maintaining data quality and adherence to U.S. healthcare payer standards.
Summary Generated by Built In
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
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
Equal Employment Opportunity Statement
We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicable law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.
Skills Required
- HealthEdge platform experience
- Health payer operations experience
- Electronic Data Interchange transactions, especially 834 Member Enrollment
- Member enrollment and eligibility process experience
- Understanding of U.S. healthcare payer business processes
- Knowledge of HIPAA regulations and healthcare data standards
- Strong analytical and problem-solving skills
- Bachelor's degree in Healthcare Administration, Business, Information Technology, or a related field
- Minimum 12 years of experience
- 15 years of full-time education
- 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
- Healthcare reporting and operational metrics experience
- HealthEdge or healthcare operations certifications
- Strong communication and stakeholder management skills
- Healthcare payer production support and operations experience
Accenture Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Accenture and has not been reviewed or approved by Accenture.
-
Healthcare Strength — Pay is considered competitive when paired with robust insurance options and other perks that compare well with large consulting and IT services peers. Multiple national medical plan options plus dental and vision are positioned as a core strength of the overall package.
-
Retirement Support — Retirement support is positioned as a standout feature through a 401(k) dollar-for-dollar match up to a set percentage after eligibility. The package is reinforced by additional financial programs such as savings tools and related resources.
-
Parental & Family Support — Parental and caregiving supports are presented as a meaningful benefit differentiator through substantial paid parental leave and multiple caregiver-oriented programs. Backup care and fertility/adoption/surrogacy navigation and reimbursements add breadth to family support beyond leave alone.
Accenture Insights
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
Accenture is a global professional services company with leading capabilities in digital, cloud and security. Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Interactive, Technology and Operations services—all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 500,000+ people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities. Visit us at www.accenture.com.
