Claims Quality Analyst

Role Overview

• Audit claim data for Medicare Part D, Medicaid, and Exchange lines of business to validate their accuracy.
• Assist with post-implementation monitoring to validate adjudication-related fixes/enhancements are working as expected.
• Assist with Claims Adjudication testing by running test claims.
• Work in partnership with the Technical Operations Business Analysts and Product Managers to manage changes to existing processes, including defining requirements, creating/executing test plans, and post-implementation oversight.
• Complete tasks associated with the assigned processes, performing appropriate oversight, coordinating the resolution of issues with both internal and external stakeholders, using independent judgement to determine the best resolution
• As needed, may require working outside of normal business hours to complete time sensitive processes
• Other duties as assigned

Requirements

• Bachelor/Associate Degree in business related field; or equivalent combined education and experience preferred
• 1
• 3 years related work experience preferably in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5%
• No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!