Claims Systems Analyst
Posted on Mar 10, 2019 by Beacon Health Options
We are currently seeking a dynamic Claims Systems Analyst to join our team at our office in Latham, NY!
About the Position:
We are currently seeking a dynamic Claims Systems Analyst to join our team at our office in Latham, NY! The Claims Systems Analyst will be responsible for interfacing with the Claims Department, client, and IT teams to identify business requirements., communicate and resolve claims issues, and project manage resolution tasks. This position w ill require monthly, short term travel to engagement center and/or client site.
- Monitor and report all claims associated to the FFP (Federal Financial Participation) process. This position ensures that all eligible claims are reported to the state timely and accurately.
- Work with large amounts of data to determine business requirements and claim status.
- Owns the extract claim issue resolution process, including project managing solutions, status reporting, and escalation progression.
- Interface with the Claims Department, IT, and other operational departments to develop and implement solutions for claim related issues.
- Interface with client at regular on-site meetings and telephonically to clearly present data analysis and solutions.
- Analyze business requirements to communicate and understand design specifications that include business rules, data mapping tables, logical flow charts, edit logic, etc.
- Participate in a lead role to identify issues, monitor tasks, and ensure expected results.
- Devises or modifies procedures to solve complex problems surrounding claim results. Under general direction, formulates and defines objectives through research and fact-finding combined with a good understanding of business systems and industry requirements.
- Serves as the primary liaison between Claims Department and Client on topic of claim submissions for federal matching.
- Will require monthly, short term travel to engagement center and/or client site
- Education: High school diploma or equivalent required.
- Bachelor's Degree in Computer Science, Management Information Systems or related discipline preferred.
- Relevant Work Experience: 2 years' experience in a claims role accompanied with a minimum of five (5) years' experience in an analysis role required.
- Health insurance/Medicaid industry knowledge strongly preferred.
- Knowledge, Skills, Abilities:
- Detailed understanding of data analysis and file structures.
- Advanced Excel skills required. Access ability desired.
- AS400 knowledge desired
- Strong analytical and problem solving skills required
- Strong written and verbal communication skills required
- Understanding of claims extract and response file requirements
- Familiar with Federal Financial Participation (FFP) desired
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
AAP Reporting Location:
NY - Latham
ID (Req #):