Claims Operations Analyst

The Opportunity

Claims Operations Analyst will be responsible for gathering, creating requirements, performing all aspects of claims testing and ensuring gaps and risks are mitigated to produce expected claim outcomes within the required timeframes. The Claims Operations Analyst will work closely with the Claims team and the Plan Build team and report to the Director, Claims Operations.

What you will do

• Gather and develop business requirements to ensure claim processing produces the desired outcomes
• Build claim requirements and provide to other departments, vendors and key stakeholders initiating other projects to ensure other understand what the claims department needs to be successful
• Develop claim test scenarios and test plans
• Responsible for comparing current business practices and systems with the desired future state
• Document results, findings, and solutions.
• Complete the claim testing in the various test environments and upon test sign off validate specific outcomes continue within production
• Lead the Investigation of reported incidents, including performing root cause analysis, communicating with affected stakeholders, and designing and implementing internal controls to prevent similar incidents from occurring in the future.
• Collaborate and coordinate with cross function teams to identify and propose actionable solutions
• Accountable to resolve issues, defects and concerns related to testing
• Responsible for analyzing large data sets to find efficiencies and make recommendations on solutions to improve claims processes.
• Effectively communicate with team members, vendors, and stakeholders.
• Oversee the test environments in collaboration with Plan build, IT and VBA to ensure environment is refreshed and ready for successful execution of testing.
• Document outcomes and train others on developed solutions.

What we expect from you

• 3-5 years of defining business process and analysis to support healthcare claims processing
• 2-3 years of claims testing and/or Claims quality auditing
• BA degree or equivalent experience
• Strong knowledge of healthcare claims lifecycle
• VBA knowledge or proven experience in learning claims systems
• Proven ability to effectively communicate with stakeholders and vendors
• Self-starter and the ability to work independently
• Ability to demonstrate creativity, act independently and respond to highly ambiguous situations
• Advanced verbal, written communication and interpersonal skills to successfully interact with internal and external audiences.
• Ability to influence others to achieve business unit objectives

We make healthcare EZ!

Additional Opportunity Details:

Target Base Compensation Range for this role is $78,000-98,000*

* Factors that may be used to determine your actual salary include your job specific skills, education, training, job location, number of years of experience related to this role and comparison to other employees already in this role.

Employee benefits are part of the competitive total rewards package that HealthEZ provides to you. Our comprehensive benefits program includes health benefits, retirement plan (401k), paid time away, paid leaves (including paid parental leave) and more.

HealthEZ recognizes its responsibilities under federal, state, and local laws requiring non-discriminatory employment practices. All employment decisions, practices and procedures will be carried out without regard to race, color, creed, religion, sex (including pregnancy), sexual orientation, national origin or ancestry, age, marital status, disability, family status, status with regard to public assistance, or any other characteristic protected under applicable local, state, and federal laws.

HealthEZ is proud to be an equal opportunity employer.