Medicare Advantage Claims and Enrollment AnalystBookmark This
Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems,reporting and new products/programs to improve customer service levels and overall quality.
Assist and support in the planning, coordinating, developing and implementing of approved projects which are Divisional and/or Corporate in scope in order to enhance the overall efficiency of operational procedures, methods, controls, and performance. Analyze, process and/or expedite operational transactions; this may include timely resolution of problems. Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process. Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives. Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters communications and graphics. Assist personnel (both internal and external) by answering questions, supplying information and training. Represent department and division as requested on work groups and special assignments. Develop and maintain an effective working relationship with customers or partners. Other duties may be assigned.
- Bachelor's Degree in related field preferred.
- Two (2) to five (5) years experience in related field is required.
- Demonstrated knowledge/competency in the following areas: claims or inquiry processing experience preferred, analytical experience, ability to produce statistical information from conceptual needs, and working with PC application and/or mainframe systems preferred.
- Effective verbal and written communication skills.
- Ability to lead and contribute to process improvement programs.
- Excellent interpersonal skills necessary to interact with all levels of all personnel.
- Other related skills and/or abilities may be required to perform this job.
- Must have knowledge of CMS rules and regulations for claims and enrollment.
- Must have a claims and/or enrollment background in a Medicare Advantage Organization.
- Previous experience with IKA systems highly preferred.
- Must have the ability to manage vendors.
- Person must be able to demonstrate strong analytical skills