Eligibility and Accumulator Analyst

Svitla Systems Inc. is looking for an Eligibility and Accumulator Analyst for a full-time position (40 hours per week) in Europe. Our client is a U.S.-based healthcare technology company specializing in pharmacy benefits management and data-driven pharmacy care. The company combines clinical expertise, advanced analytics, and technology to help organizations manage prescription drug benefits, improve member health outcomes, and optimize healthcare costs. Its solutions support complex pharmacy benefits operations, including claims processing, eligibility management, and data-driven clinical and operational workflows.

You will join the Production Support team responsible for ensuring the accuracy and reliability of inbound and outbound data files, as well as monitoring eligibility, accumulator, and claims-related processes. The role involves responding to production incidents, investigating data and eligibility issues, resolving support tickets, and ensuring that critical workflows are functioning correctly.

You will support a portfolio of approximately 6 - 8 third-party administrators (TPAs), including vendors and multiple clients, representing approximately 30 - 40 client accounts in total. You will monitor data processing and operational performance across this portfolio, identify issues and emerging trends, and work with internal teams to drive timely resolution.

The client is expanding its monitoring capabilities and investing in automation while continuing to rely on analysts to manually validate data and system behavior and ensure that automated processes are working as expected. This role is therefore well suited to a detail-oriented, analytical professional with experience in healthcare eligibility, accumulators, or claims, combined with strong data analysis and issue-resolution skills.

Working hours : till 3 pm EST

• Mandatory experience working in the healthcare domain.
• 4+ years of professional experience in a related field.
• Bachelor's degree in Computer Science, Information Technology, or a related discipline.
• Moderate to advanced proficiency in SQL.
• Experience reviewing and understanding complex Python notebooks.
• Strong data analysis skills and experience working with large datasets.
• Hands-on knowledge of medical and pharmacy claims processing, eligibility structures, and accumulators.
• Experience working with regulated data and compliance requirements, including GDPR, HIPAA, PHI, and PII.
• Strong attention to detail and a commitment to producing accurate and reliable results.
• Strong analytical and problem-solving skills, with the ability to investigate issues, identify root causes, gather relevant information, and develop effective solutions.
• Ability to take initiative, make informed recommendations, and proactively identify opportunities for improvement.
• Strong critical-thinking and time-management skills.
• Proficiency in troubleshooting and resolving technical issues.
• Effective communication skills and the ability to collaborate successfully in a team environment.
• Provide technical support to customers by assisting with product-related issues, troubleshooting, and escalations.
• Monitor inbound and outbound file exchanges, including file receipt, processing, and outbound file generation.
• Monitor data quality, eligibility, and accumulator performance for assigned vendors and clients.
• Execute SQL queries to retrieve, update, and analyze data within relational databases.
• Analyze large datasets to identify trends, investigate issues, and determine root causes.
• Proactively identify and assess issues, risks, and emerging trends across assigned workflows.
• Drive the analysis and assessment of issues to determine root causes and develop comprehensive solutions.
• Develop and implement mitigation plans in alignment with established KPIs.
• Make recommendations on technical solutions and communicate requirements to technical teams.
• Facilitate the escalation process when necessary, ensuring timely resolution of critical issues.
• Ensure that data is accurate, secure, and handled in accordance with organizational policies and applicable regulatory requirements.
• Create and maintain clear documentation for data processing workflows, code, analysis procedures, and issue resolution processes.
• Document and track support cases in the knowledge management system for future reference.
• Collaborate closely with team members and cross-functional teams to understand project requirements and deliver accurate results.
• Support testing activities for new configurations and validate their impact on data processing and system behavior.
• Identify opportunities for operational improvements and provide actionable feedback to internal teams.
• Develop proactive solutions and contribute ideas that support continuous improvement of processes and data workflows.
• Actively participate in team meetings and contribute technical insights, recommendations, and ideas for process improvement.