Business Analyst (Claims)

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Support the Claims Department unit for daily functions, project initiatives, and special projects as directed by the Claims Director or their designees. The projects will typically encompass developing and running ad-hoc reports, software implementations, system upgrades, and third party software modifications.

• HS diploma; Bachelor's Degree or Associates Degree in a health related field preferred
• Three to five years prior managed care experience in a health insurance company
• Experience working with technology, systems and IS departments
• Strong knowledge of Microsoft SQL Server Management Studio
• Knowledge of ICD-9 and CPT-4 coding and medical terminology
• Knowledge of Medicare, Medicaid federal and state regulations as it pertains to claims processing
• Testing, data validation, and data flow experience is a plus
• Proficient in Windows, Word, Excel; Crystal and SQL
• Knowledge of Visio and PowerPoint a plus
• Excellent written and oral communications skills
• Technical experience or aptitude is essential
• Experience in Claims processing or IT environment is required
• Ability to interact with end users and foster cooperation is critical to the job
• Prioritization skills to handle multiple tasks aligning with claims management goals is essential to the job