Marketplace Eligibility & Enrollment Business Analyst

Position Overview

The Marketplace Eligibility & Enrollment Policy Analyst position provides leadership, technical expertise, and coordination of Get Covered Illinois’s activities related to eligibility and enrollment business policy, system design, operational development, and procedures. The position will analyze complex State and Federal policy and operational requirements and document and implement those requirements through the functional components of the GCI marketplace IT platform. The Marketplace Eligibility & Enrollment Policy Analyst will also coordinate activities related to developing, implementing, and maintaining eligibility and enrollment business design requirements and functionality for the GCI marketplace. The position will work closely with internal GCI staff as well as staff from the Departments of Healthcare and Family Services and Human Services to develop, document, and implement policies and processes for eligibility and enrollment for all relevant healthcare programs, as well as internal processes relating to customer service. We invite all qualified candidates to apply.

Get Covered Illinois is the State of Illinois’s new Health Insurance Marketplace. Get Covered Illinois’s mission is to increase access, enrollment, affordability, and choice for individuals and families by connecting them to health insurance plans and savings available through the Affordable Care Act. Get Covered Illinois provides pathways to coverage through a consumer-centric online application platform, a Customer Assistance Center, localized outreach and education strategies and a network of in-person assisters embedded in communities across the state that help Illinoisans enroll in the coverage that best meets their families’ needs. Get Covered Illinois is part of the Illinois Department of Insurance and has offices in Chicago and Springfield.

Why Work for Illinois?

Working with the State of Illinois is a testament to the values of compassion, equity, and dedication that define our state. Whether you’re helping to improve schools, protect our natural resources, or support families in need, you’re part of something bigger—something that touches the lives of every person who calls Illinois home.

No matter what state career you’re looking for, we offer jobs that fit your life and your schedule—flexible jobs that provide the gold standard of benefits. Our employees can take advantage of various avenues to advance their careers and realize their dreams. Our top-tier benefits and great retirement packages can help you build a rewarding career and lasting future with the State of Illinois.

Essential Functions

• Under the direction of the Marketplace Eligibility and Enrollment Director, serves as the statewide Marketplace Eligibility & Enrollment Policy Analyst: utilizes in-depth knowledge and understanding of the Patient Protection and Affordable Care Act (ACA) and related rules, regulations, and guidance to implement Get Covered Illinois (GCI) policy, eligibility, and enrollment initiatives; monitors proposed and enacted laws and regulations at the state and federal levels and analyses impacts to GCI systems, processes, and business operations; provides guidance to the agency, in consolidations with senior leadership, on new and revised legislative, legal, and operational initiatives impacting GCI eligibility and enrollment; develops in-depth knowledge of Illinois public healthcare programs administered by the Department of Healthcare and Family Series (HFS) and Department of Human Services (DHS) and how these programs interact and integrate with the GCI marketplace; interprets, analyzes, and summarizes research from government, academic, and nonprofit sources relating to state healthcare policy and exchange operations, and provides guidance to the agency based on this research; participates in inter-agency and cross-state policy discussions and collaborations; leverages subject matter expertise on healthcare policy and ACA eligibility and enrollment to collaborate with other GCI business areas and to implement or advance marketplace policy, business, and operational needs.

Essential Functions Cont'd

• Leads, in consultation with senior leadership, IT solution development, including requirements gathering, functional review, and vendor collaboration, to ensure alignment of IT processes with policy and business needs: completes extensive research and reviews proposed and planned IT system changes and provides policy feedback, analysis, and implementation guidance; evaluates and directs implementation of system customizations, configurations, and enhancements in accordance with GCI policy and operational needs; analyzes proposed and newly enacted state and federal regulatory requirements and assesses impact on system design and business processes; identifies opportunities to integrate and realize state health policy goals within the design and implementation of the GCI marketplace; provides policy guidance to and participates in user acceptance testing, defect and release management, vendor coordination, and IT operations support as needed.
• Provides policy guidance and direction in support of GCI operations across multiple business areas: assists with conducting research to develop, evaluate, and implement operational unit policies, procedures, and guidelines; acquires in-depth understanding of key stakeholder business, policy, and operational needs within the context of GCI eligibility and enrollment; implements internal procedures, provides technical assistance in the development of policy manuals, guidance, and reference materials used by GCI operations staff; provides eligibility and enrollment policy expertise and analysis for appeals, audits, escalations, and other operational and compliance processes; creates and reviews consumer-facing written information including website materials, healthcare application content, FAQs, and notices; anticipates business needs and ensures that GCI operational processes and procedures are accurate, effective, and aligned with changing state and federal regulation; provides technical assistance in creating and implementing robust corrective action plans that sustain short and long-term solutions; shares educational and informational materials with Division staff for staff development and learning purposes; assists senior leadership with special projects within the designated time frames and format.
• Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

Minimum Qualifications

• Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college, preferably with courses in business or public administration.

• Requires two (2) years of responsible administrative experience in a public or business organization.

Preferred Qualifications

• Prefers at least two (2) years of experience interpreting federal or state policy within the context of government, health care, or IT operations. 

• Prefers at least three (3) years of experience with the Affordable Care Act and/or state-based healthcare insurance exchanges. 

• Prefers at least three (3) years of experience with eligibility and enrollment policy and systems related to Medicaid, the Affordable Care Act, or other government programs. 

• Prefers at least three (3) years of experience gaining a deep understanding of federal policy and regulatory frameworks. 

• Prefers at least three (3) years of experience utilizing knowledge and understanding of health care policy and systems. 

• Prefers at least three (3) years of experience communicating complex information in a clear and concise manner. 

• Prefers a Master’s Degree in public administration, policy, business administration or a related field, or a Juris Doctorate. 

Specialized Skills

• Of the two (2) years of experience above, requires two (2) years of experience interpreting federal or state policy within the context of government, health care, or IT operations.

Conditions of Employment

• Requires the ability to pass a background check.

• Requires ability to travel in the performance of duties, with overnight stays as appropriate.

• The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job description.

About the Agency

The Department of Insurance (DOI) regulates the insurance market in the State of Illinois including, but not limited to, licensing and educating insurance agents, investigating Workers Compensation fraud, and examining the operations and finances of insurance companies domiciled in the state. We are committed to protecting consumers and regulating the insurance industry with innovation and efficiency. DOI has approximately 220 employees who are split between our Chicago and Springfield offices.

State of Illinois employees enjoy a robust benefit package, including:

• Health, Life, Vision, and Dental Insurance
• 13 Paid Holidays annually, 14 on even numbered years
• 10-25 days of Paid Vacation time annually - (10 days in year one of employment)
• 12 Paid Sick Days annually (sick days carry over from year to year)
• 12 Weeks Paid Maternity/Paternity Leave
• 3 Paid Personal Days annually
• Pension Plan
• Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
• Flexible work schedules may be available, dependent upon position
• Tuition Reimbursement Program and Federal Public Service Loan Forgiveness Program eligibility

Visit https://www2.illinois.gov/cms/benefits/Pages/default.aspx for more information about our benefits.

Work Hours: M-F; 8:30am - 5:00pm

Work Location: 115 S. LaSalle Street, 13th Floor, Chicago, IL 60603

Agency Contact Email: DOI.HR@illinois.gov

Posting Group: Leadership & Management

Apply at: https://illinois.jobs2web.com/job/Chicago-Marketplace-Eligibility-&-Enrollment-Policy-Analyst-IL-60603/1270290500/