Claims Operations Analyst

Job Details

Salary Range
: $78,000.00 - $98,000.00 Salary

Claims Operations Analyst will be responsible for gathering, creating requirements, performing all aspects of claims testing and ensuring gaps and risks are mitigated to produce expected claim outcomes within the required time frames. The Claims Operations Analyst will work closely with the Claims team and the Plan Build team and report to the Director, Claims Operations.

• Gather and develop business requirements to ensure claim processing produces the desired outcomes
• Build claim requirements and provide to other departments, vendors and key stakeholders initiating other projects to ensure others understand what the claims department needs to be successful
• Develop claim test scenarios and test plans
• Responsible for comparing current business practices and systems with the desired future state
• Document results, findings, and solutions.
• Complete the claim testing in the various test environments and upon test sign off validate specific outcomes continue within production
• Lead the investigation of reported incidents, including performing root cause analysis, communicating with affected stakeholders, and designing and implementing internal controls to prevent similar incidents from occurring in the future.
• Collaborate and coordinate with cross function teams to identify and propose actionable solutions
• Accountable to resolve issues, defects and concerns related to testing
• Responsible for analyzing large data sets to find efficiencies and make recommendations on solutions to improve claims processes.
• Effectively communicate with team members, vendors, and stakeholders.
• Oversee the test environments in collaboration with Plan build, IT and VBA to ensure environment is refreshed and ready for successful execution of testing.
• Document outcomes and train others on developed solutions.

• 3-5 years of defining business process and analysis to support healthcare claims processing
• 2-3 years of claims testing and/or Claims quality auditing
• BA degree or equivalent experience
• Strong knowledge of healthcare claims lifecycle
• VBA knowledge or proven experience in learning claims systems
• Proven ability to effectively communicate with stakeholders and vendors
• Self-starter and the ability to work independently
• Ability to demonstrate creativity, act independently and respond to highly ambiguous situations
• Advanced verbal, written communication and interpersonal skills to successfully interact with internal and external audiences.
• Ability to influence others to achieve business unit objectives

Wemakehealthcare

EZ!

Additional Opportunity Details :

Target Base Compensation Rangeforthisroleis  $78,*

* Factors that may be used to determine your actual salary include your job's specific skills, education, training, job location, number of years of experience related to this role and comparison to other employees already in this role.

Employeebenefitsarepartofthecompetitivetotalrewardspackagethat

Health

EZprovidestoyou.

Ourcomprehensivebenefitsprogramincludeshealthbenefits,retirement plan(401k),paidtimeaway,paid leaves(includingpaidparentalleave) andmore.

Health

EZrecognizesitsresponsibilitiesunderfederal,state,andlocallawsrequiringnon-discriminatoryemploymentpractices.

Allemploymentdecisions,practicesandprocedureswillbecarriedoutwithoutregardtorace,color,creed,religion,sex(including pregnancy),sexual orientation,nationaloriginorancestry,age,marital status,disability,family status,statuswithregardtopublicassistance,oranyothercharacteristicprotectedunderapplicablelocal,state,andfederallaws.

Health

EZ is proud to be an equal opportunity employer.