Client Setup Quality Analyst

1 week ago


Philadelphia, Pennsylvania, United States Integrity Staffing Solutions Full time

We're searching for a Client Setup Quality Analyst to join our client, a leading health insurance company based in the Philadelphia area.

Job Summary:

  • Review and audit client benefit setup and changes.
  • Conduct detailed group setup audits to identify accuracy and compliance issues, ensuring high-quality setup for clients.
  • Responsible for ensuring accuracy in medical product/benefit, pharmacy, and other ancillary products.
  • Oversee and review audit results to verify compliance with setup requirements and client's contracted benefits.
  • Identify new audit areas through trend analysis or audit samples.

Responsibilities:

  • Collaborate with Product teams and Sales to discuss client benefits and setup.
  • Identify trends and opportunities for process improvement through audit findings.
  • Conduct audits of client setup documents and benefit templates.
  • Document audit findings, draft summaries, and present reports to Sales.
  • Audit new business groups for account installation in line with Underwriting guidelines.
  • Audit client benefit changes, administration changes, and cancelations following Client Set Up and Underwriting Guidelines.
  • Ensure required documentation is obtained, product information is accurate, and rates are confirmed before group approval or benefit changes processing.
  • Meet production standards and quality requirements.
  • Properly document and track inventory.
  • Address inquiries from Account Executives, Brokers, and others regarding departmental procedures.
  • Resolve issues related to group setup and benefit changes.
  • Handle errors and issues effectively to maintain turnaround times.
  • Build and maintain positive client relationships.
  • Contribute to special projects related to customer implementation and changes.
  • Suggest process changes to improve departmental efficiency.
  • Perform additional assigned duties.

Qualifications:

  • Preferred Bachelor's Degree or 3-4 years of relevant experience.

Experience:

  • Minimum 4 years of relevant experience required; Audit experience is a plus.

Knowledge, Skills, Abilities:

  • Thorough knowledge of audit processes and requirements.
  • Understanding of healthcare products, benefits, and systems.
  • Effective project management skills.
  • Ability to work independently and prioritize workload.
  • Strong communication skills and ability to interact at all levels.
  • Excellent time management and organizational skills.
  • Ability to analyze data and identify patterns.
  • Strong problem-solving and critical thinking skills.
  • Technical aptitude including Microsoft Office proficiency.

If you meet the above requirements, please submit your application along with your resume for consideration.

Integrity Staffing Solutions is an Equal Opportunity Employer:

About Integrity Staffing Solutions:

We are dedicated to connecting top talent with leading companies nationwide. Let us be your Opportunity Engine, taking the hassle out of job hunting and getting you hired. Join us today to kickstart your journey



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