Marketplace Eligibility & Enrollment Business Analyst

Position Overview

The Marketplace Eligibility & Enrollment Business Analyst will be part of Get Covered Illinois’s Eligibility and Enrollment Team. The Marketplace Eligibility & Enrollment Business Analyst is engaged in all policy, system design and operational development for GCI’s eligibility and enrollment program. With limited direction, the Marketplace Eligibility & Enrollment Business Analyst works closely with GCI, the Departments of Healthcare and Family Services, Human Services and Innovation and Technology staff to provide solutions for improving and enhancing operational processes and functions of the programs by analyzing and developing system requirements, providing policy and system expertise in developing system design, and recommending system controls and protocols for GCI. This position develops and monitors processes and procedures across policy, system, and operational business areas to ensure GCI’s programs comply with state and federal requirements, within the scope of Illinois’s health care reform efforts and the Patient Protect

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 Business Analyst: works with internal Get Covered Illinois (GCI) business staff, the Department of Innovation and Technology (DoIT), and IT vendors on ongoing program analysis, system development, and support; analyzes current business systems and processes and implements improvements; reviews planned and proposed system changes, communicates feedback, and assesses impact to business policies and procedures; provides guidance to the agency, in consultation with senior leadership, on system customizations, configurations, and enhancements in accordance with GCI policy and operational needs; manages relations between GCI business units and vendor IT staff, ensuring coordination, alignment, and effective communication between business and technical teams; elicits, analyzes, and documents business requirements for system functionality and implements operational procedures based on the policy and operational needs of GCI, partner agencies, and external stakeholders.

• Tests and validates business IT systems to ensure that they satisfy GCI business and functional requirements and are ready for production use: manages business user acceptance testing (UAT) to ensure successful deployment of new systems and system features; prepares and implements test plans, scripts, and schedules relating to end-to-end system testing and integration; manages issues identified during testing and after deployment; completes extensive research and documents and organizes system test results, behaviors, issues, and risks; collaborates with UAT vendor to review test case outcomes, provide business direction, and coordinate vendor activities with other agencies and business units as needed.

• Manages and implements operational processes and procedures and ensures effective coordination between business operations and IT activities: assists with conducting research to develop, evaluate, and implement operational unit policies, procedures, and guidelines; manages system gaps and issues raised by GCI staff, end users, and external stakeholders; collaborates with IT vendor staff and other GCI business units to evaluate and prioritize system defects and implement corrective actions; provides operational and IT system expertise to support audits, appeals, escalations, and other operations and compliance processes; provides technical assistance in the development of reference materials used by GCI operations staff and end users including FAQs, SOPs, release notes, and other documents; directs changes to system behavior and operational processes.

Essential Functions Cont'd

• Creates, analyzes, and utilizes reports and extracts of marketplace eligibility and enrollment data to inform and guide business decisions: collaborates with vendor and GCI reporting staff to produce and validate reports of QHP eligibility and enrollment data, including but not limited to application trends, enrollment activity, subsidies, and data matching issues; analyzes system performance, including determining impacts of technical issues, verifying expected outcomes, and quantifying effects of proposed and implemented system changes; uses multiple data sources to assess and improve integration with public program systems, including Account Transfer activity, mixed eligibility households, and dual coverage between public and private healthcare programs; reviews and validates external reporting related to GCI eligibility and enrollment; 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 performing business analysis 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 strong analytical skills with experience that includes: root cause analysis, business case development, gap analysis, process mapping, requirements management, design documentation. 
• Prefers at least three (3) years of experience learning new systems and business processes while working with ambiguity and rapid change in a fast-paced environment. 
• Prefers at least three (3) years of experience refining business and system needs into clear and concise requirements that can easily be understood by technical and non-technical groups, including experience translating technical information to non-technical audiences.
• Prefers at least three (3) years of stakeholder analysis skills. 
• Prefers at least three (3) years of experience with systems testing, to include developing and executing test cases, 
• Prefers at least three (3) years of demonstrated strong problem-solving skills. 
• Prefers at least three (3) years of Prefers at least three (3) years of experience working with complex datasets using Microsoft Excel or similar software. 

Specialized Skills

• Of the two (2) years of experience above, requires two (2) years of experience performing business analysis 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.