Claims Analyst

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Job description

Innova Solutions is immediately hiring for a Benefit Analyst

Position type: Fulltime/Contract to Hire

Location: Philadelphia, PA 19103

Duration: 06 Months

As a Benefit Analyst you will:

Job Summary:

• Auditing Client Benefit Setup and Changes
• Performs comprehensive group setup audits to identify processor accuracy and/or compliance issues to ensure quality setup for clients
• Responsible for quality review of medical product/benefit accuracy, pharmacy, and other ancillary products.
• Oversee and review audit results from business vendor to ensure products are compliant with set up requirements and Client's contracted benefits.
• Identify new audit areas by trend analysis or audit samples.

Responsibilities:

• Participate with Product teams and Sales in discussions regarding client benefits and setup.
• Identify trends and process improvement opportunities through audit findings. Collaborate with client setup team members, Sales and Product Management on discrepancies and errors to be corrected.
• Conducts audits of client setup documents, including benefit templates. Responsible for client specific benefit template audits.
• Document audit findings, draft audit summaries and comprehensive audit reports and present to Sales.
• Audits Account Installation new business groups for in accordance with the established Underwriting guidelines.
• Audits client benefit changes, administration changes and cancelations in accordance with the established Client Set Up and Underwriting Guidelines.
• Must 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 Set up, Brokers, Enrollment and Billing.
• Triage and resolve issues related to group set-up and benefit changes.
• Handle errors and internal/external issues in a timely and effective manager to maintain turnaround times for completion o of customer/group set-up.
• 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.

Education:

• Bachelor's Degree preferred. In lieu of degree, must have 3-4 years relevant experience.

Requirement:

• 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 process 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.
• Must be able to work independently.
• 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.
• Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer.
• Ability to review and analyse 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. Demonstrated experience with Microsoft products (Word, Excel and Power Point.)

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.

We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW .

Thank you!

Prakash Bhagat

Sr. Associate - Recruitment

(+1) 678-831- 5493

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