Benefits Configuration Specialist

1 week ago

Long Beach, California, United States Advanced Medical Manage Full time
Job Overview

Position Title: Benefits Analyst I

Position Summary:

The Benefits Analyst I plays a crucial role in managing all facets of benefits configuration. This includes programming, reviewing, and auditing benefit setups to ensure accurate programming for Authorizations and Claims.

Key Responsibilities:

  • Utilize Health Plan websites to gather benefits information for members.
  • Contact Health Plans to confirm member benefits.
  • Verify eligibility concurrently while checking benefits.
  • Collaborate with the Benefits team to establish standards and conduct random audits.
  • Document and communicate findings with the Benefits team.
  • Ensure systems are responsible, reliable, and responsive to the needs of all IPAs.
  • Monitor and audit processes to meet strategic objectives.
  • Create and maintain Option Masters for each benefit option provided by the Health Plan by Line of Business (LOB).
  • Implement data integrity initiatives for benefits configuration and other operational areas.
  • Coordinate, document, and develop projects while maintaining high organization.
  • Assist various departments with inquiries via email and phone, including verifying information with health plans.
  • Oversee daily benefits management.
  • Input and update benefits for all Health Plans and IPAs' lines of business.
  • Manage the addition of options in EzCap for the Eligibility Department.
  • Program, review, and update benefits in EzCap daily.
  • Assist in downloading Benefits Online.
  • Run reports to identify benefit discrepancies.
  • Recommend process improvements, including policies and procedures.
  • Support training and development initiatives for the AMM team.
  • Respond to inquiries promptly and provide necessary support.
  • Coordinate with various departments to resolve benefits inquiries or system-related issues.
  • Exercise good judgment to plan and achieve goals.
  • Perform a variety of tasks as needed.
  • Administer and ensure timely completion of all projects.
  • Other duties may be assigned as necessary.

Education & Experience Requirements:

  • Preferred: College Degree.
  • Experience in benefits configuration and interpretation.
  • Ability to work effectively with all levels within the organization.
  • Highly organized with the capacity to manage multiple tasks efficiently.
  • Proficient in software applications such as EZCAP is advantageous.
  • Familiarity with Microsoft Office Suite (Word, Excel, Outlook, Access).
  • Demonstrated initiative, self-motivation, and strong work ethic.
  • Strong time management skills with the ability to prioritize multiple deadlines.
  • Consistently produce accurate and high-quality work.
  • Ability to thrive in a fast-paced environment.
  • Strong analytical and problem-solving skills are essential.
  • Possess a positive attitude and excellent communication skills.
  • Ability to work independently and collaboratively within a team.

This position offers a unique opportunity for individuals seeking to grow within the healthcare industry, contributing to a culture of innovation and professional development.

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