Seasonal Customer Service Quality Policy Analyst I

The Seasonal Customer Service Quality Policy Analyst I plays a significant role on a fully remote team supporting case analysis and reconciliation of data from the health insurance exchange. Each Seasonal Customer Service Quality Policy Analyst I must be able to work independently and maintain the confidentiality of the information they encounter. A Seasonal Customer Service Quality Policy Analyst I must 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 are unique in nature and require close attention to detail.

Key Responsibilities:

The Analyst is responsible for efficient, timely, hands-on troubleshooting, remediation, coordination, escalation, tracking, and management of complex consumer enrollment disputes. The Analyst is also responsible for conducting research and workflow investigations, reviewing business procedures, and recommending improvements to all aspects of the casework adjudication process.

• Identifying and solving customer information and processing problems.
• Applying triage, research, collaboration, and technical knowledge to resolve transaction and processing issues.
• Analyzing discrepancies in the eligibility reconciliation process for multiple stakeholders.
• Serving as a subject matter expert regarding the Health Insurance Marketplace.
• Providing day-to-day guidance to assigned team members when appropriate.
• Coordinating with technical and development teams to resolve identified issues in a timely manner.
• Reviewing documented training material for accuracy and assisting with end-user training and support.
• Driving continuous process improvement of the reconciliation process.
• Providing content for, and collaborating with, training staff to train stakeholders on transaction triage and the reconciliation process.
• Processing 834 file submissions through Advanced Resolution.
• Undertaking additional duties as assigned by the Manager.

What a Typical Day Looks Like

Morning: Case Review & Triage You'll start by reviewing your assigned caseload and any new escalations that came in overnight. Each case is different — some are straightforward eligibility discrepancies; others are multi-layered disputes involving conflicting data across systems. Part of your day is spent triaging: deciding what needs immediate attention, what can be researched in depth, and what may need to be escalated to a technical or development team.

Midday: Investigation & Problem-Solving This is the core of the role. You'll dig into the data — reconciling eligibility records, tracing where a discrepancy originated, and figuring out whether it's a data entry issue, a system processing error, or something else entirely. You'll process 834 file submissions through Advanced Resolution and work independently to troubleshoot and remediate issues, using your judgment to determine the right path forward when there isn't a clear-cut answer.

Afternoon: Coordination & Collaboration Cases rarely get resolved in isolation. You'll likely coordinate with technical and development teams to resolve issues that go beyond casework, and you may serve as a go-to subject matter expert for colleagues with Marketplace-related questions. If you're one of the more experienced analysts, you may also provide day-to-day guidance to teammates, review training materials for accuracy, or contribute to training stakeholders on triaging transactions and reconciliation.

Throughout the Day: Documentation & Process Improvement Beyond individual cases, you'll be expected to notice patterns — recurring issues, workflow inefficiencies, or gaps in existing procedures — and recommend improvements. Contributing to continuous process improvement isn't a side task here; it's part of how the team gets better over time.

What Makes Someone Successful in This Role

• Comfortable with ambiguity. Many cases won't have a documented playbook. You'll need to research, use sound judgment, and make a call.
• Detail-oriented. Small discrepancies in data can have real consequences for a consumer's coverage.
• Self-directed. This is a remote role with real autonomy — and real accountability for your caseload.
• A natural communicator. You'll translate technical/data issues into plain language for stakeholders, and sometimes for consumers directly.
• Trustworthy with sensitive information. You'll handle confidential consumer data every day.

This role suits someone who enjoys investigative problem-solving over repetitive process work. It's less about volume and more about depth — getting each case right, even when it takes real digging. If you thrive on variety and don't mind working through ambiguity independently, this role offers a lot of ownership. If you prefer clearly defined, repeatable tasks with minimal variation, this may not be the right fit.

Required minimum qualifications:

• Associates Degree OR High School Diploma/GED and 2 years of relevant experience.
• 2 years additional relevant experience.
• Must be a US Citizen.
• Must be able to pass federal background investigation that grants access to government systems.

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

Preferred qualifications:

• Experience with the Affordable Care Act.
• Strong written and oral communication skills.
• Advanced customer service telephone skills and willingness to make outbound and receive inbound calls.
• Experience with complex data analytics and advanced problem solving.
• Proficiency in Microsoft Word, Excel, PowerPoint, and SharePoint.
• Experience with Federal contracts desired.
• Experience with the 834 enrollment transaction process desired.
• Ability to remain engaged in a remote work environment.

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.