Full-Time Operational Claims Systems Analyst
Job Description
Our Client is dedicated to International Corporations, Institutions and Global Organizations, Insurers and Health Carriers. They provide worldwide Remote Medical & Security Services, Business Travel Risk Management and International TPA & Cost Containment Services.
1. ACCOUNTABILITY OBJECTIVE:
• Accountable for reviewing, analyzing and building benefits for all policies.
• Accountable for ensuring eligibility and member data is uploaded regularly in alignment with our client’s standards, and reports inconsistencies and supporting resolutions.
2. SCOPE
• Works professionally and effectively with all employees, in a high volume, fast-paced environment.
• Communicates professionally and regularly with external clients and vendors (patients, clients and health care providers).
• Have the ability to decipher functional discrepancies from the operational aspect into workable IT solutions, and then being able to translate it back into functional workflows and terms so that the Operations can work efficiently for the end user.
3. RESPONSIBILITIES
• Reviews policy documents and validates with system functionality, working with client and vendor to ensure appropriate set-up.
• Works closely with other benefits experts within the organization to ensure new/renewal policies are read, understood and implemented in a timely and appropriate fashion.
• Ensures that all setups align with policy documents and guidelines provided by the insurer and UWs within stipulated timelines as per agreed SLA’s with clients.
• Ensures best practices are followed in eligibility management and benefit setup process which allows for a seamless efficient processing cycle.
• Works closely with staff in the department to determine benefit/eligibility challenges and seeks systemized automated solution while working closely with the system vendor.
• Determines training requirements as a result of eligibility and benefit setup issues, ensures that adequate information about change or new setup is dispersed and trained across impacted staff in the organization
• Maintains and reviews eligibility files and other related reports regularly; monitoring for any upload issues.
• Maintains, reviews and responds to issues logged into the eligibility and benefits log while working in close collaboration with vendor manager and supervisor to ensure timely review and completion of outstanding issues.
• Responsible for maintaining system code sets – CPT, ICD, payment, denial, and other reason codes.
• Presents oneself as a subject matter expert for any benefit/eligibility setup related discussions/ projects/queries.
• Designs, develops and maintains policies and procedures and ensures they are well documented and in compliance with our client’s standards.
• Develops benefit setup guides and maintains strict adherence to ensure standardization.
• Configures policies and products into appropriate system using industry experience and best practices to ensure maximum automation.
• Performs system audits and checks to ensure all benefit setups are completed in a timely and orderly manner.
OTHER
• Adheres to all policies and procedures as outlined in the Employee Handbook and client specific protocols.
• Performs all work in a PIPEDA and HIPAA compliant manner.
• Works in compliance with the Occupational Health and Safety Act and related legislation.
• Ensures strict standards for claimant/client confidentiality and complies with organizational and governmental regulations/policies
4. YOUR KNOWLEDGE AND EXPERIENCE
• Minimum 2 years experience in major medical and international medical expat policy setups or health insurance industry experience.
• Post secondary education or related equivalent experience.
• Excellent understanding of insurance policy language and interpretation skills to set it up.
• Superior verbal and written communication skills.
• Experience in implementing best of class rule engines in insurance space an asset.
• Second language an asset.
5. EFFORT & WORKING CONDITIONS
• Discretion in dealing with confidential/sensitive information.
• Coordination and prioritization of time sensitive tasks.
• Critical and analytical thinking required.
• Proficient and accurate data entry skills.
• Lack of control over work pace or priorities.
• Concentrated attention for prolonged periods of time.
• Works in a typical call centre office environment and the noise level is moderate
• Sitting for long periods of time.
In return for your unique skill set, logical thought process and desire to improve upon everything you do, you will
receive:
• A competitive salary and annual bonus program
• Extended health and dental benefits
• An RRSP matching program of up to $4000 per year
• Free parking
• A chance to make a difference
How to Apply
To apply, please contact: Rachel Hoevenaars VP Underwriting & Risk Management, My Insurance Recruiter (416) 844-3261 rachel@myinsurancerecruiter.ca Job Ref# JOS000000192670 total views, 1 today
