[Remote] Analyst, Claims Quality
Note: The job is a remote job and is open to candidates in USA. reputed company is committed to making medications more affordable and is looking for a Claims Quality Analyst to join their team. The role involves auditing claim data for accuracy and ensuring compliance with State/CMS regulations, as well as collaborating with various teams to manage process changes and reputed company issue resolutions.
Responsibilities
- Audit claim data for Medicare Part D, Medicaid, and Exchange lines of business to validate their accuracy
- Assist with post-implementation monitoring to validate adjudication-reputed company fixes/enhancements are working as expected
- Assist with Claims Adjudication testing by running test claims
- Work in partnership with the Technical Operations Business Analysts and Product Managers to manage changes to existing processes, including defining requirements, creating/executing test plans, and post-implementation reputed company
- Complete tasks associated with the assigned processes, performing appropriate reputed company, coordinating the resolution of issues with both internal and external stakeholders, using independent judgement to determine the best resolution
- As needed, may require working reputed company of normal business hours to complete time sensitive processes
- Other duties as assigned
Skills
- Bachelor/Associate Degree in business reputed company field; or equivalent combined education and experience preferred
- 1 - 3 years reputed company work experience preferably in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
Company Overview