Claim Benefit Analyst

Purpose: This position will identify and resolve claims issues via audits and review of web accounts and claims system. In addition, this position will develop tools and processes for our Claims Benefit program.

Principal Accountabilities:

• Function as a claim and claim system(s) expert for account management, clients, and others within and outside Definity Health
• Support account management, partners, members, clients and customer service representatives in resolving claims, implementation, and other issues
• Conduct claim demonstrations, workflow and operations reviews with existing and potential customers
• Improve processes by developing and implementing creative solutions to process breakdowns and member dissatisfiers
• Audit member accounts and account histories · Insure claims adjustments are requested and completed in a timely fashion
• Ensure production and operating excellences by auditing claim operations
• Assist in defining, documenting and communicating claims process, policies, and procedures Insure claim system(s) supports all aspects of DH products including medical management, provider networks, benefit plans, etc.
• Liaison with IS, TPA, and others during enhancement development and through implementation
• Work closely with Claim Manager to insure company and client goals are met or exceeded
• Assess cost and workflow implications of client specific non-standard requests
• Projects as assigned

Requirements:

• BS/BA degree preferred or equivalent work experience
• Five years of healthcare industry experience in an operations role with claims administration focus
• Medical claim processing experience strongly preferred · Detailed technical knowledge of medical claims processing · Strong general knowledge of operations that interface with claims including quality assurance, customer service, billing and eligibility and other related operations
• Demonstrated problem solving skills
• Ability to make sound, fact based decisions balancing cost and quality
• Demonstrated customer orientation
• Ability to prioritize and manage multiple tasks simultaneously · Demonstrated results orientation and ability to execute on goals
• Excellent written and verbal communication skills
• Strong interpersonal, collaboration and teaming skills

To apply for this position, please contact us at jobs@definityhealth.com and attach your resume in a Microsoft Word document.

Equal Opportunity Employer. All rights reserved.