Case Management Specialist
3 weeks ago
An employer is looking for Business Analysts in the San Diego, Ca area. These candidates should be able to use business analysis skills and due diligence to research the root cause of escalated member cases. Business Analyst will then provide a resolution on such escalated member case. Always an influx in cases due to the new year and will need help with the volume of requests.
- Focuses on case resolution with emphasis of coverage issues to ensure no discrepancies exist among systems, with our members' complaints
- Supports daily Business Case Development through timely analysis and resolution of member complaints by performing research and review through multiple systems.
- Perform / timely follow up through member cases.
- Ability to communicate with members when required.
Must-haves:
- 3+ years' experience as a Business Analyst or analytical role or case management
- Healthcare Background in one or more of the following:
- Healthcare Insurance Experience
- Healthcare Billing Experience
- Grievance/Appeals in healthcare setting
- Case management in healthcare setting
- Epic experience is a big plus
- Oracle experience is a big plus
- Healthcare Exchange experience
- Excellent research and analysis skills
- Excellent documentation skills
- Experience with case management
- Previous customer service experience
- Microsoft Suite (excel, outlook)
- Experience in healthcare or insurance industry
- Experience creating pivot tables, inputting, and exporting data in Excel
- Flexibility to adapt to and to follow ongoing process changes
- Must be able to proactively work in a collaborative Team Environment, demonstrating development of positive relationships with peers
- Analytical skills -- a must, in order to perform accurately and timely on cases, to ensure a first time full resolution is achieved
- Great communication skills to timely provide feedback on issues that might affect multiple members
Plusses:
- Case resolution experience
- Root cause analysis
- Previous Kaiser experience
- SharePoint experience
Compensation:
$40-$43/hr.
Exact compensation may vary based on several factors, including skills, experience, and education.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.
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