Primary Purpose:

• Based on assignment and under minimal direction of management, responsible for applying business knowledge and skills to assist, organize and coordinate projects, and support operations that will improve or enhance the administration of benefits through claims processing and other supporting functions that includes but is not limited to increasing the level of automation, problem identification and resolution, improving work-flows and procedures, develop and review reports, develop or revise appropriate documentation, and unit and system testing for all Lines of Business.
• You will perform a variety of multi-faceted tasks to include identification of issues and data collection, analysis and interpretation, and documentation to develop or substantiate internal and external business proposals.
• You will be assigned to lead and coordinate business projects of low to medium complexity.

Duties:

• Gathers, reviews and analyzes Claims data to identify issues, and potential problems and solutions related to development and implementation, including but not limited to new products or services, contract deliverables, enhancements to add functionality and/or redesigns of systems, both manual and automated, to improve efficiency, financial models of costing and pricing.
• Utilize the data analysis skills and experience including but not limited to SQL queries to pull or download appropriate data or reports from processing systems required for the analysis
• Develops forward thinking, data driven recommendations and strategies that align with business objectives and based on logical assumptions and facts considering resources, constraints, and Employer values.
• Delivers critical pieces of analysis and research to drive new insights and actively and openly shares with appropriate parties to encourage collaboration for improvement and change. Translates analysis into solutions and/or options for consideration of specific actions, including business process improvements.
• Initiates change and evaluates impact. Plans and executes all initiatives for maximum impact but minimal disruption to our key stakeholders. Promotes and processes product efficacy – translates large volumes of data, testing and experiments into clear recommendations and responses to constantly changing business environments. Provides quality, objective, and professional analysis

Required:

• 5 years related experience in Healthcare Payer industry or Health insurance
• 3 years related experience in Claims processing or Configuration support for Healthcare Payer or Health insurance
• Basic knowledge of performing Claims analysis using SQL databases
• Experience on HealthEdge / HealthRules Payer (HRP) or FACETS or QNXT

Preferred:

• All the minimum requirements above.
• Bachelor’s degree in business administration, Health Care Administration, or a related field.
• Ability to communicate (oral and written) and present to all staff levels to include management and vendors.
• Organizational skills and the ability to multi-task are essential.
• Must be able to work in a fast-paced environment, perform effectively under dynamic conditions such as directional changes, tight deadlines, and limited resources.
• Strong interpersonal skills.
• Proficiency in Microsoft Office and the Internet.
• Knowledge of basic mathematic skills.
• Proficiency in issues identification and data collection, analysis, and interpretation.
• Strong customer focus and team orientation skills.
• Ability to work independently and collaboratively.
• Occasional evening and weekend time as required to meet business needs
• Experience in a claims processing environment or related job function.
• Working knowledge of medical terminology and codes.
• Knowledge of health care industry trends.
• Working knowledge of project management methods

⚠️ Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or @firstsource.com email addresses.