Case Processing Specialist I

The Case Analyst I plays a significant role on a fully remote team supporting case analysis and reconciliation of data from the health insurance exchange. As a Case Analyst I, you will be part of a team responsible for collecting and reconciling data from several proprietary data sources, and for following defined standard operating procedures to remediate cases for both consumers and health insurance issuers. Each Case Analyst I must be able to work independently and maintain the confidentiality of the information they encounter. A Case Analyst IImust be flexible and engaged to meet daily expectations and adapt to changes in casework. It is imperative that a successful candidate be proactive, exercise good judgment, and demonstrate strong initiative, as most cases will be unique in nature and require close attention to detail.

Training consists of a two-week, instructor-led virtual training course followed by a one-week job shadow. Analysts who complete 30 days of employment in good standing will receive a bonus. Analysts who remain through the duration of the assignment in good standing will receive a second bonus.

Key Responsibilities:

• Utilize data analysis experience and skills for research, remediation, case management, and troubleshooting to support American consumers who obtain health insurance through the Federally Facilitated Marketplace (FFM).
• Demonstrate exceptional customer service skills when speaking with consumers via a cloud-based telephony solution to gather additional information needed to adjudicate their case and to inform them of the outcome.
• Contribute to workflow investigations, business procedures, and process improvements.
• Perform duties in a dedicated, secure area within your residence.
• Work within a coordinated team while being individually responsible for appropriately triaging, adjudicating, and, when necessary, escalating consumer dispute cases that require advanced subject-matter expertise.
• Work an assigned shift within the hours of 8:00 AM–8:00 PM Eastern Time, Monday through Friday.
• Leadership may assign additional duties within the scope of the project.

What a typical shift looks like:

Case queue review — You'll start by reviewing your assigned caseload, prioritizing based on urgency and Service Level Agreements (SLA) date.

Data reconciliation — For each case, you'll dig into multiple data sources to reconstruct what happened: Did the consumer's enrollment information match what the issuer received? Where did the data diverge, and why?

Consumer calls — Several times a day, you'll speak directly with consumers by phone (via a cloud-based telephony platform) to gather missing information or explain the outcome of their case — sometimes good news, sometimes not. These conversations require patience and clear, empathetic communication, since consumers are often calling about something that affects their health coverage and yearly tax filing.

Case adjudication — Using standard operating procedures, you'll determine the appropriate resolution for each case and document your findings thoroughly.

Escalations — Not every case fits neatly into a procedure. When a case requires advanced subject-matter expertise or falls outside normal parameters, you'll escalate it appropriately rather than force a fit.

Process improvement input — Periodically, you'll be asked to weigh in on workflow issues or suggest process improvements based on patterns you're noticing in your casework.

What makes someone successful in this role

• Comfortable working independently for extended stretches, with minimal real-time oversight.
• Able to stay engaged and focused in a remote setting, day after day.
• Detail-oriented — small discrepancies in data can matter a lot.
• Good judgment for knowing when to follow procedure versus when to escalate.
• Professional and calm on the phone, even in difficult conversations.
• Trustworthy with confidential consumer and health information.
• Adaptable when priorities or procedures shift.

Required minimum qualifications:

• Associates Degree OR High School Diploma/GED and 2 years of relevant experience.
• Must be a US Citizen and be willing to undergo a federal background investigation in order to be granted access to sensitive information.

Candidates that do not meet the required qualifications will not be considered.

Preferred qualifications:

• Experience following defined processes or assignments.
• Proficient in the use of MS Office including Word, Excel, PowerPoint, and Outlook.
• Experience with complex data analytics and advanced problem solving.
• Ability to work in a fast-paced, deadline-driven environment.
• Ability to remain engaged in a remote work environment.
• Strong written and oral communication skills.
• Ability to work overtime as required.

Compensation Ranges

Compensation ranges for ASM Research positions vary depending on multiple factors; including but not limited to, location, skill set, level of education, certifications, client requirements, contract-specific affordability, government clearance and investigation level, and years of experience. The compensation displayed for this role is a general guideline based on these factors and is unique to each role. Monetary compensation is one component of ASM's overall compensation and benefits package for employees.

EEO Requirements

It is the policy of ASM that an individual's race, color, religion, sex, disability, age, sexual orientation or national origin are not and will not be considered in any personnel or management decisions. We affirm our commitment to these fundamental policies.

All recruiting, hiring, training, and promoting for all job classifications is done without regard to race, color, religion, sex, disability, or age. All decisions on employment are made to abide by the principle of equal employment.

Physical Requirements

The physical requirements described in "Knowledge, Skills and Abilities" above are representative of those which must be met by an employee to successfully perform the primary functions of this job. (For example, "light office duties' or "lifting up to 50 pounds" or "some travel" required.) Reasonable accommodations may be made to enable individuals with qualifying disabilities, who are otherwise qualified, to perform the primary functions.

Disclaimer

The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.