Claims Business Systems Analyst (closed)
Position Code, Title and Location: 5863 - Claims Business Systems Analyst - Westerville, OH
Start Date: ASAP
Type: contract-to-hire or direct hire
Remote or Onsite: On location at the Client’s site 100% of the time. No telecommuting or remote work.
Additional Information: Health Care and Benefits Available
Description: For over 40 years, our Client has been the leading provider of outsourced distribution, sales, benefits administration, customer service, and retention solutions to the insurance industries. By employing close to 1,000 employees and serving nearly 1.5 million members, the company’s clientele includes many Fortune 500 companies. Their dedication to treating their employees with utmost care and respect is demonstrated by an outstanding retention rate – most employees have worked with the company for more than 8 years. It is a place that encourages growth, fosters talent and promotes a synergistic approach to team collaboration.
· Provide support to staff regarding claim system and configuration documentation;
· Resolve claims pended to BSA's in a timely fashion and report findings;
· Create, send, update, resolve issues in Referral Database;
· Update client specific documentation and reference materials;
· Under general supervision, analyze and interpret client benefit plans and update information systems to accurately reflect client specific benefit plan details;
· Assist with testing of information systems to ensure proper configuration of benefit plans;
· Recommend changes in policies, procedures, or services to management based on benefit/contract changes;
· Participate in client facing meetings and related direct communication efforts as needed.
· 3+ years experience as a Claims Examiner;
· 1+ year experience in health claim auditing including medical, dental and vision;
· Strong knowledge of CPT, ICD-9, and HCPCS coding;
· Strong knowledge of interpreting Plan Documents including Eligibility, Exclusions and Limitations;
· Strong working knowledge of Claims Systems;
· Healthcare background (preferred);
· Experience with Beacon Spyglass Software (preferred);
· Experience with ClaimFacts (preferred);
· US Citizens and Permanent Residents only.
End of Description