Job Description:Healthcare Domain - Member enrollment & eligibility — X12 834 maintenance, retro adjustments, deeming, 820 premium linkage, reconciliation across Medicaid/MA/Duals/MMP/TRICARE/MarketplaceCore Skills Needed - Facets (REQUIRED), X12 EDI (834, 820, 270/271), SQL, TOSCA, ADO, enrollment reconciliationCore technical & domain requirements:Facets — REQUIRED: membership/enrollment module testing, subscriber/member configuration, and 834-to-Facets data flow validationX12 EDI: 834 (Benefit Enrollment & Maintenance) — full transaction expertiseMember add/change/term, dependent handling, dual-enrollment scenariosRetroactive adjustments and deeming logic (Medicaid/MMP/Dual)820 (Premium Payment) validation linkageMember eligibility cross-validation (270/271 correlation)Enrollment reconciliation: source system vs.



downstream (enrollment DB ↔ claims ↔ eligibility)SQL for member-level data comparisons (effective dates, plan codes, LOB flags)TOSCA or similar automation toolLOB knowledge: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, MarketplaceResponsibilities:Design enrollment scenarios including retro, term, and dual-enrollment.Build/maintain automation; lead 820 linkage and 270/271 correlation testing.Lead reconciliation between 834 source and downstream member records.Own offshore enrollment test design across LOBs and deeming logic.Drive automation coverage and mentor analysts.Conduct RCA on eligibility and reconciliation discrepancies.

📌 Sdet Engineer - Member Enrollment & Eligibility (Pune)
🏢 r3 Consultant
📍 Pune