Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.
Summary of Position
The Benefit Plan Analyst reports to the Chief Administrative Officer. This position will be responsible to ensure, accurate, timely implementation of benefit plans into the claims adjudication system, development, testing, deployment, and documentation of plan/benefit designs for new and existing business. This position will build the plan design within the FIS-SunGard iWork’s claim adjudication system using knowledge of benefit design, and data elements. Additionally, the BPA will collaborate and work with the Client Relations Consultant Division regarding implementation, set up and maintenance resulting in assured adherence to desired formulary goals for Consociate Health clients.
Essential Duties and Responsibilities
- Programs benefit plans into adjudication platforms accurately.
- Establish and maintain plan controls.
- The job involves an elements of quality improvement such as system modifications to improve efficiencies, increase auto adjudication, troubleshooting, etc.
- Implementation of adjudication rules.
- Claim testing to ensure accurate claim adjudication.
- Acts as liaison between CRC division and other internal stakeholders, to coordinate receipt of required information for system programming, reporting and claim adjudication process, this includes the following tasks:
- Attends implementation meetings to discuss technical requirements and protocols.
- Maintains working knowledge of CH Systems and procedures.
- Communicates updates and changes in a timely manner to appropriate stakeholders.
- Ability to understand reporting requirements and program plan accordingly.
- Analyzes reports to research and resolve discrepancies, errors, and problems.
- Provides issue resolution related to benefit plan and/or claims adjudication.
- Serves as liaison between client technical team and claims adjudication vendor for both routine work and special projects.
- Creates and maintains plan/benefit design documentation.
- Works collaboratively with staff to ensure effective communication and is the subject matter expert (or resource) for benefit plan set up and maintenance.
- Interacts with IT to coordinate plan/benefit design changes.
- Recommends new and enhanced system logic to support plan/benefit design.
- Makes recommendations to streamline the work processes, create efficiency and assist with updates.
- Researches plan/benefit design options and requirements as required.
- Provides optimum customer service.
Knowledge, Skill, and Abilities:
- Program/project management experience preferred.
- A.A. degree or higher desired.
- Proficient with medical coding including ICD-10, HCPCS, CPT, CDT, Revenue codes.
- Knowledge of EDI Business Practices for institutional and professional bills.
- Knowledge of Medical Terminology.
- Claims processing experience and/or claims auditing.
- Plan document/ Plan benefit understanding (Health, Dental, STD, Vision, etc.
- Strong analytical skills.
- Knowledge of ACA and HIPAA-the application of regulatory compliance regarding benefits.
- Excellent verbal and written communication skills.
- Proficient with multiple computer applications.
- Experience working with internal and external client personnel.
- Advanced use of Microsoft Office Products (ex. Excel skills: V-lookups, formulas, ability to create, edit and run reports).
- Experience in Benefit Plan Administration.
- Present a positive image of Consociate at all time.
- Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer, co-worker, producer or supervisor.
- Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
- Identify and perform work that has not been specifically assigned, as needed.
- Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries. Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
- Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Administration Division.
- Attend required in-service and staff meetings.
- Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
Physical and Mental Abilities
- Ability to perform sedentary work for extended periods of time.
- Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of customers.
- Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.
- The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.
- Work is performed in a normal office environment.
- There is minimal exposure to hazardous or unpleasant working conditions. Overtime as needed may be requested.
- Travel as needed may be requested.
As a Third Party Administrator of employee benefits, we are seeking talented individuals to join our team. We prefer candidates with previous experience, strong organizational, verbal, and written skills. Salary commensurate with experience. Benefits include paid time off, group medical, life, disability, dental, voluntary vision, flexible spending account, health savings account, and 401K with match.
Full job descriptions are available upon request. Consociate offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others. Please forward your resume to firstname.lastname@example.org
Consociate Health is an Equal Opportunity Employer