Claims Analyst
1 month ago
Job Title: Senior Client Setup Quality Analyst
Join our team as a Senior Client Setup Quality Analyst and make a significant impact by ensuring accuracy and compliance in client benefit setup and claims auditing. This is an exciting opportunity for individuals with experience in HealthRules, healthcare claims auditing, and benefits configuration, who are eager to work in a fast-paced, client-focused environment.
Key Responsibilities:
- Perform comprehensive audits of client benefits and setup before and after implementation.
- Prepare and execute claims test scenarios to validate benefit accuracy, including ancillary setup as required.
- Collaborate with Sales, Client Implementation, and Audit teams to identify issues, trends, and opportunities for process improvements.
- Review client benefit setup to ensure compliance with contracts and setup requirements.
- Assist the Configuration team in building and verifying benefit plans.
- Document audit results, communicate findings, and present comprehensive audit reports.
- Ensure benefit changes and administration updates are processed according to guidelines.
- Manage departmental inquiries and provide resolutions to benefit setup issues.
Qualifications:
- Bachelor’s degree preferred, or 3-4 years of relevant experience.
- Minimum 4 years of experience in benefits and claims, with a focus on auditing and quality review.
- Experience with HealthRules Manager/Designer highly preferred.
- Strong knowledge of healthcare products, benefits, systems, and audit processes.
- Exceptional organizational skills, attention to detail, and ability to meet deadlines.
- Ability to work independently and communicate effectively across teams and with clients.
- Proficiency with Microsoft Office (Word, Excel, PowerPoint).
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