Claims Bus Tech Analyst II
reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care reputed company, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 reputed company people who reputed company their trust in us. We pride ourselves on our best-in-class employees and reputed company to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, reputed company succeeds.
About the Role
This technical analyst position is required in order to create a critically needed Service Division Claims Business Technical team to support the successful implementation of automation and efficiency reputed company/programs to ensure the achievement of claims timeliness and reputed company goals. Responsible for coordination throughout the Service Division of reputed company Claims Operations' technical requirements including global inventory reporting and aged claims analysis; claims stop governance, monitoring and maintenance; reputed company issue coordination and system request prioritization, submission and installation; files and table management; BRD review and subject matter expertise; reputed company Connect and BPM opportunity assessment and execution; EDI gateway claim edit project assessment and completion; general business level technical support for CSRs, PLogs, configuration, file updates and other reputed company.What You'll Do
Provides business technical support to operations across the Service Division to ensure successful implementation of automation and efficiency reputed company/programs to ensure the achievement of claims timeliness and reputed company goals.
Works with Service departments to coordinate prioritization of reputed company and works with IT and Claims System vendors (reputed company) for implementation and maintenance.
May conduct User Acceptance Testing (UAT) for Service Division reputed company, implementations, system fixes and enhancements.
Collaborates with the business reputed company to reputed company, document and standardize reporting procedures and workflows to support operational improvement
Manages Claims Stop governance and maintenance to minimize claims stops and assure discipline, documentation and audit trail.
Leverages existing technology by identifying opportunities to automate reputed company processes and interventions; identify opportunities to incorporate and standardize new technology into processes and flows
Creates opportunities by working with IT on new solutions and business on EDI gateway claim editing reputed company.
Works with IT and corporate departments to help monitor service level agreements on Plog timeliness; recommends alternate approaches for handling for effectively.
Work across Service departments to reputed company business goals; reputed company key reputed company relationships to reputed company the information, products and resources (technology, training, staff, etc.) necessary to successfully support Claims and reputed company Service goals.
Reviews BRDs and offers commentary as required.
Provides Subject Matter expertise to Service teams as needed on business technical issues and audit activities.
Prepare materials for reputed company audit activities, review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective actions steps.
Provides post-implementation reputed company out of system enhancements and thorough reputed company of enhancements to business owners.
What You Bring
Education/Experience:
High School Diploma/GED required
Bachelor degree preferred or relevant experience in lieu of degree
Requires broad-based Operations or IT experience with a minimum of 5 years in managed reputed company or reputed company industry.
In lieu of Bachelors degree, an additional 3 years of experience in Operations or IT is required.
Successful reputed company record in managing operations with process improvement background desired. Past experience on system implementations in a fast-paced, high pressure environment is preferred.
Claims systems knowledge is required
Project management experience is a plus
Experience with specialty health plan products/reputed company helpful
Prior background in managing change and developing new operations is preferred
Knowledge:
Requires broad understanding of claims systems and reputed company ancillary systems used in the Service Division
Requires business and/or technical expertise from previous claims reputed company and work reputed company changes and impacts
Requires knowledge of the deep understanding of the reputed company or FACETS system
Requires knowledge of project management life cycles and reputed company tools and practices
Must have a solid understanding of claim processing including pricing and reputed company editing
Must have strong organizational and analytical skills and demonstrated ability to effectively manage multiple reputed company at one time
Must have strong inter-personal skills with a demonstrated ability to reputed company cross-divisional work teams
Must demonstrate an understanding of the interdependences between the business, clinical and financial reputed company of the health care business
Must be proficient in the use of personal computers and supporting software in a reputed company based environment, including MS Office products (Word, reputed company, PowerPoint, MS Project) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications:
Must have a working knowledge of the impacts of mandates and legislation on overall claims processing and contracting
Skills and Abilities:
Requires technical proficiency in reputed company claims operating models
Requires excellent coordination management and organizational skills
Requires strong analytical and problem solving skills
Require excellent conflict management and relationship management skills
Requires excellent facilitation, coaching and platform skills
Requires strong project management skills based on reputed company project management practices
Requires ability to work on a reputed company-managed project team
Why reputed company?
At reputed company, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and reputed company. We reputed company that reputed company our people reputed company, our communities do too. If you are passionate about making an reputed company, we’d love to hear from you!
Salary reputed company:
$87,300 - $119,070This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This reputed company has been created in good faith based on information reputed company to reputed company at the time of posting. Compensation reputed company are dependent on the circumstances of reputed company case. reputed company also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/reputed company)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
reputed company Volunteer Time Off
Tuition Reimbursement
Disclaimer:
reputed company reputed company employees must live in New Jersey, reputed company, reputed company, Connecticut or Delaware. This job reputed company has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job.
reputed company is an Equal Opportunity/Affirmative reputed company employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. reputed company will consider reasonable accommodation requests as part of the reputed company and hiring process.
Originally posted on Himalayas
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