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Client Setup Quality Analyst
4 months ago
Job Summary:
- Auditing Client Benefit Setup and Changes
- Performs comprehensive group setup audits to identify processor accuracy and/or compliance issues to ensure quality setup for clients
- Responsible for quality review of medical product/benefit accuracy, pharmacy, and other ancillary products.
- Oversee and review audit results from business vendor to ensure products are compliant with set up requirements and Client’s contracted benefits.
- Identify new audit areas by trend analysis or audit samples.
Responsibilities:
- Participate with Product teams and Sales in discussions regarding client benefits and setup.
- Identify trends and process improvement opportunities through audit findings. Collaborate with client setup team members, Sales and Product Management on discrepancies and errors to be corrected.
- Conducts audits of client setup documents, including benefit templates. Responsible for client specific benefit template audits.
- Document audit findings, draft audit summaries and comprehensive audit reports and present to Sales.
- Audits Account Installation new business groups for in accordance with the established Underwriting guidelines.
- Audits client benefit changes, administration changes and cancelations in accordance with the established Client Set Up and Underwriting Guidelines.
- Must ensure necessary documentation is received, product information is accurate, and rates are confirmed before the group is approved or benefits changes are processed.
- Meet departmental production standards and quality requirements.
- Properly document and track assigned inventory.
- Respond to inquiries regarding departmental procedures/policies from Account Executives, Client Set up, Brokers, Enrollment and Billing.
- Triage and resolve issues related to group set-up and benefit changes.
- Handle errors and internal/external issues in a timely and effective manager to maintain turnaround times for completion o of customer/group set-up.
- Develop and maintain positive client relationships with internal and external customers and Account Executives.
- Participate in special projects regarding customer implementation and changes.
- Recommend process changes to increase departmental efficiency.
- Perform additional duties as assigned.
Qualifications:
Education:
- Bachelor’s Degree preferred. In lieu of degree, must have 3-4 years relevant experience.
Experience:
- Minimum 4 years relevant experience required; Audit experience preferred. Auditing, quality review or transaction processing experience required.
Knowledge, Skills, Abilities:
- Considerable knowledge of audit processes and requirements, including organization and storage of documentation. Well versed in best practice process and procedures.
- In-depth knowledge of healthcare products, benefits, and systems.
- Proven effectiveness in managing to project targets and deadlines. Demonstrated effective project management skills necessary.
- Must be able to work independently.
- Ability to audit client documents to ensure benefits and products are set up correctly.
- Flexibility and adaptability are a must.
- Willingness to be cross trained is required to assist other team members.
- Strong communications skills required – position interacts with all levels of management and may communicate with external clients as well.
- Excellent time management and organizational skills required. Ability to prioritize workload and meet deadlines in a fast-paced environment without supervision.
- Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements and implementation are complying across operational disciplines.
- Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer. Ability to review and analyze data to identify patterns of incorrect benefit setup and benefit application of the setup in accordance with sound audit methods and practices.
- Must be strong problem-solver and be able to follow-up and take an issue to resolution.
- Strong understanding of benefits and underwriting rating methodology. Capability to understand Underwriting guidelines and apply them.
- Strong critical thinking skills.
High level technical aptitude required - ability to use Microsoft Office and to learn proprietary and vendor systems. Demonstrated experience with Microsoft products (Word, Excel and Power Point.)
If you have the above experience, please APPLY NOW and include your resume for consideration
Integrity Staffing Solutions is an Equal Opportunity Employer:
By clicking apply now on this page and by submitting your profile and application you authorize Integrity Staffing Solutions to contact you regarding job openings and agree and authorize that Integrity may use regular and automated calls or text messages to alert you of job openings. By submitting this application, you are confirming that the telephone number you provide is the number you are requesting we use to contact you and that you are permitted to use and are authorized to receive calls, automated calls, or texts on this telephone number. You also understand that you are required to notify Integrity of any change to your phone number during the application process. You can opt out of receiving these communications at any time. You can opt out of receiving these communications at any time by simply pressing 3 any time during an automated call, or by entering STOP after a text message.
About Integrity Staffing Solutions:
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