Help improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.
About the Role
This is an opportunity to be part of a team that directly impacts global healthcare systems. As a Claims Business Process Analyst, you will work with a dynamic and diverse team to build a better healthcare system for everyone.
* You will assist in the review of disputes, eligibility analysis, and preparation of arbitration briefs in support of compliance with federal and state surprise billing laws.
* You will contribute throughout the Independent Dispute Resolution (IDR) process, focusing on briefing and submission of documentation to an independent arbiter.
This role requires strong analytical skills, attention to detail, and effective communication. You will be responsible for cogently responding to requests from various stakeholders, including CMS, arbiters, providers, clients, and management.
Responsibilities
Your primary responsibilities will include:
* Responding to inquiries from stakeholders
* Preparing arbitration briefs
* Identifying issues, analyzing EOBs and claims information, applying critical thinking skills to formulate a plan of action, and resolving issues independently
* Triage complex issues to management
* Managing multiple priorities in a time-sensitive manner
* Working in a fast-paced, high-volume environment with quick turnaround time
* Communicating effectively utilizing strong business writing skills
* Prioritizing and managing workload to meet deadlines, goals, and objectives
* Collaborating with coworkers in a cohesive team environment
The Ideal Candidate
We are looking for a skilled and motivated individual who possesses:
* Bachelor's Degree (or higher) OR equivalent work experience
* Experience analyzing and solving customer problems
* Experience root cause analysis utilizing data
* Litigation/legal background or investigative support experience
* Experience with Microsoft Excel (data entry, pivot tables); Microsoft Word; Microsoft Outlook; Microsoft PowerPoint
What We Offer
As a valued member of our team, you can expect:
* A dynamic and supportive work environment
* Ongoing training and development opportunities
* A competitive compensation package
* Opportunities for career advancement
Contact Information
We are an equal opportunities employer and welcome applications from all qualified candidates.