Claims Analyst

4 weeks ago

Philadelphia, Pennsylvania, United States Innova Solutions Full time
Job Summary

Audit and review client benefit setups and changes to ensure accuracy and compliance with established guidelines.

Key Responsibilities
  • Conduct comprehensive audits of client benefit setups and changes to identify potential issues and areas for improvement.
  • Collaborate with product teams and sales to discuss client benefits and setup requirements.
  • Identify trends and process improvement opportunities through audit findings and work with the team to implement changes.
  • Document audit findings and present results to sales and other stakeholders.
  • 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 setup, brokers, enrollment, and billing.
  • Triage and resolve issues related to group setup and benefit changes.
  • 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.
Requirements
  • Minimum 4 years relevant experience required; audit experience preferred.
  • Auditing, quality review, or transaction processing experience required.
  • Considerable knowledge of audit processes and requirements, including organization and storage of documentation.
  • Well-versed in best practice processes 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.
  • 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.
  • 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, 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.
Benefits

Innova Solutions offers benefits (based on eligibility) that include the following:

  • Medical & pharmacy coverage
  • Dental/vision insurance
  • 401(k)
  • Health saving account (HSA) and Flexible spending account (FSA)
  • Life Insurance
  • Pet Insurance
  • Short-term and Long-term Disability
  • Accident & Critical illness coverage
  • Pre-paid legal & ID theft protection
  • Sick time, and other types of paid leaves (as required by law)
  • Employee Assistance Program (EAP)
About Innova Solutions

Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion.

Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

  • One of Largest IT Consulting Staffing firms in the USA – Recognized as #4 by Staffing Industry Analysts (SIA 2022)
  • ClearlyRated Client Diamond Award Winner (2020)
  • One of the Largest Certified MBE Companies in the NMSDC Network (2022)
  • Advanced Tier Services partner with AWS and Gold with MS

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment.

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