We are staffing for an excellent benefits company that has incredible employee engagement, amazing retention and they are looking for their next team member! This is an awesome opportunity that will provide you with room for growth and awesome longevity! It would be ideal if this person had claims experience since that is the department they would be working in but if you have prior BA & tech experience please fill out an application!
- Responsible for technical assistance to the Claims unit. Responsible for ensuring technical workflows, coding updating, entering plan changes in system and general system assessment support.
- Develops plan changes implementation work plan and plan comparisons to assure accuracy of system configuration
- Review of system workflows with testing of workflow to ensure desired system results, with recommendation of workflow implementation with significant organizational financial impact. Manages workflows and maintain workflow history of Vitech system.
- Provides the research and analysis of proposed benefit changes to confirm the benefit change can be applied within the current system configuration or if additional programming is required and confirm findings with vendor.
- Provides research and analysis of claim payment trending as well as Auto Adjudication performance.
- Provides root cause analysis for systemic challenges and production deficiencies.
- Development of production quality assurance plan and implementation.
- Coordinates internal audit of business practice, implement preventative procedures, and controls.
- Coordinates and participates in the testing of upgrades and enhancements of the current software. Participates in creating testing scenarios to ensure upgraded programming matches Summary Plan Description language.
- Coordinates system issues and resolution with vendors and the Health and Welfare Services department.
- Coordinates and communicates with vendors to troubleshoot and resolve issues that prevent the finalization of claims.
Working hours: 8:00 PM - 5:00 PM
- A Bachelor's Degree in a related field or Associate's degree and 2 years of related experience.
- A combination of appropriate education and experience may be substituted for the minimum education and experience requirements.
- Experience with claims processing and claims applications.
- Strong knowledge of plan benefits and system workflows.
- 10% travel required.
- Knowledge of medical, dental and sick leave claims processing policies and procedures.
- Interpersonal skills necessary to develop and maintain effective and appropriate working relationships with co-workers, vendors, and union representatives.
- Skill in providing high quality customer service, including assessing and resolving customer questions and needs while adhering to customer service guidelines and procedures.
- Ability to interpret and apply Summary Plan Description and plan rules, collective bargaining provisions, and the Board of Trustees directives.
- Ability to comprehend vendor specifications.
- Ability to explain complex policies and processes in layman???s terms.
- Ability to work effectively in a team environment.
- Ability to handle confidential information with discretion and tact.
- Ability to plan, develop and coordinate multiple projects.
- Ability to present ideas effectively, orally and in writing.
- Ability to prioritize departmental resources according to business objectives and deadlines.
- Ability to be self-motivated.
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