System Configuration Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee, monitor, and finalize claims and UM-related initiatives.

• Evaluate and manage intricate claim and UM situations.

• Assist in the implementation of benefits and configuration of claims/UM systems.

• Collaborate with cross-functional teams to initiate and uphold member notifications regarding claim and UM determinations and outcomes.

• Provide support for research initiatives and new business endeavors as required.

• Work alongside management to develop, revise, and sustain departmental policies and procedures.

• Conduct audits and tests on current system code rules and offer suggestions for enhancements.

• Audit and evaluate new and existing benefit configurations related to claims and UM adjudication.

• Facilitate the implementation of Crystal Reports concerning claims and UM activities.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• Bachelor's degree required.

• At least 2 years of experience in PPO and HMO claims processing, billing, and/or auditing.

• Proficient in Microsoft Office applications, including Word, Excel, and Access.

• Exceptional written and verbal communication as well as presentation abilities.

• Advanced analytical capabilities, encompassing data mining, reporting, and analysis.

• Ability to think logically, make informed decisions, and communicate effectively in diverse situations.

• Capability to handle multiple tasks and work efficiently amid interruptions or competing priorities.

• Familiarity with HSP systems.

• Knowledge of dental procedures.

• Understanding of HSP denial explanations.

• Awareness of service restrictions.

• Basic experience in data analytics.

• Previous auditing experience is preferred.

• Must be eligible to work in the United States.

• No sponsorship is available at this time.

🏝️ Benefits

• Competitive compensation structure and savings options.

• 401(k) retirement plan with employer matching, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial guidance through Financial Engines.

• Affordable medical insurance with low-cost premiums for employee-only coverage.

• 100% employer-funded dental coverage for employees and eligible dependents.

• Vision insurance with low-cost premiums for employee-only and dependent coverage.

• Company-paid basic life and AD&D insurance equal to one times the base salary, with options for additional supplemental coverage.

• Flexible Spending Accounts for healthcare and dependent care expenses.

• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.

• Long-term disability insurance coverage.

• Comprehensive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.

• Employee Assistance Program (EAP) to support mental health and well-being.

• Generous vacation and sick leave policies, with the opportunity to roll over unused time.

• 10 paid company holidays.

• Tuition reimbursement for eligible educational expenses.

• Options for remote or hybrid work available for various positions.