Claims Operations Analyst

1 month ago

philadelphia, United States IntePros Full time

IntePros is searching for a Claims Operations Analyst for our leading Healthcare client in Center City Philadelphia The Analyst works in a production environment handling transactions required as well as business support to teams as needed.


  • Handle claims production tasks such as written inquiries and reconsiderations and related adjustments to attain FEP Performance metrics.
  • Ability to assess FEP procedures and regulations and required controls and incorporating what is required into the specifications and/or documentation.
  • Identify process improvements and develop workflow and/or system recommendations.
  • Support FEP audits, including research claims related issues/questions and preparation of appropriate audit responses as well as represent the organization in the audit presentation to FEP Directors Office, BCBSA, if needed.
  • Support assigned projects related to FEP, maintain appropriate documentations at a task level, monitor deadlines and service as subject matter expert when appropriate.
  • Develop and maintain user documentation/desk level procedures ensuring the most current information is available to the claims team.
  • Work with the Business Support team in reviewing FEP release documentation and participate in testing initiatives as needed.
  • Communicate effectively in writing and verbally in work groups and with internal and external customers.
  • Attend internal and external education training to achieve and maintain proficiency on all systems.


Requirements:


  • High School Diploma or GED ,4 years’ experience in a Claims/Service operations environment OR Associate degree or minimum two-year Federal Employee Health Benefits Plan work-related experience, bachelor’s degree preferred.
  • Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements, testing and implementation are in compliance across operational disciplines.
  • Excellent written and verbal communication skills are required to provide business units with information.
  • Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result.
  • Experience in auditing, quality review or transaction processing experience.
  • Demonstrated understanding of FEP policies, processing standards and guidelines.

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