Eligibility Analyst III

Liviniti

Eligibility Analyst III ensuring quality of eligibility data for claim adjudication. Supporting testing, monitoring, and resolution of complex eligibility issues within healthcare operations.

Posted 4/11/2026full-timeRemote • Minnesota • 🇺🇸 United StatesMid-LevelSeniorWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Accountable for the quality of eligibility driving claim adjudication.
Responsible for the data integrity of upstream client eligibility to downstream eligibility shared with vendors and systems.
Responsible for testing, monitoring, issue resolution, and escalations.
Analyze and resolve complex eligibility issues impacting claims, accumulators, and member coverage.
Support root cause analysis for recurring eligibility defects and data discrepancies.
Serve as escalation support for Analyst I/II eligibility issues.
Partner with EDI, Implementation, Adjudication, and QA teams during testing and production support.
Validate eligibility data across multiple systems and identify cross-functional impacts.
Review eligibility outputs for accuracy and adherence to standards.
Maintain and enhance eligibility documentation and processing standards.
Maintain profiles on TPA/TPVs and ensure alignment with Liviniti strategies.
Support audits and internal reviews related to eligibility accuracy.
Monitor production trends and identify areas of risk or improvement.
Ensure compliance with HIPAA, security, and Liviniti standards.
Work closely with clients, vendors, and internal stakeholders to onboard new eligibility feeds and enhancements.
Identify opportunities for automation and process improvement within eligibility workflows.
Abides by all obligations under HIPAA related to Protected Health Information (PHI).

Requirements

What you’ll need

Bachelor’s degree or equivalent experience
5+ years of eligibility, EDI, or healthcare operations experience
Strong SQL & Excel skills
PBM or health plan experience strongly preferred
Experience supporting production EDI and Eligibility environments

Benefits

Comp & perks

Medical, Dental, Vision insurance
Disability and Life insurance
Employee Assistance Program
Remote work options
Generous Paid-Time Off
Annual Reviews and Development Plans
Retirement Plan with company match immediately 100% vested

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

SQLExceldata integrityissue resolutionroot cause analysiseligibility adjudicationautomationprocess improvementtestingmonitoring

Soft Skills

communicationproblem-solvingcollaborationanalytical thinkingattention to detailescalation supportclient relationsstakeholder engagementorganizational skillsadaptability