Claims Operations Analyst
HealthEZ
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $78,000 - $98,000 per year
Job Level
Mid-LevelSenior
Tech Stack
VBA
About the role
- 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.
Requirements
- 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
Benefits
- health benefits
- retirement plan (401k)
- paid time away
- paid leaves (including paid parental leave)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
business requirements gatheringclaims testingroot cause analysisdata analysistest scenario developmenttest plan developmentclaims quality auditingVBAclaims process improvement
Soft skills
effective communicationcollaborationproblem-solvingindependencecreativityinterpersonal skillsinfluencing skillsaccountabilitystakeholder engagement