Claims Data Operations Analyst (HYBRID)

$79,040 - $91,520/Yr

Bernard Nickels & Associates - Mason, OH

Full-time

Mason, OH

Administrative and Support Services

About the position

The Claims Data Operations Analyst will be a key member of the Business Configuration team, focusing on the setup and structure of benefit plans for managed vision care clients. This role requires expertise in product configuration within the Facets system, ensuring accuracy and efficiency in the configuration process while providing analytical support to troubleshoot and resolve issues.

Responsibilities

• Responsible for configuring all types of managed vision care products in the system (using both the Product Key Sheet method and manual configuration)
• Responsible for product configuration accuracy utilizing the configuration tools for manual and automated product creation.
• Write SQL queries and export from database to analyze and troubleshoot configuration issues, as well as perform issue resolution of requests.
• Perform and resolve product configuration questions/issues sent to the Business Configuration production team without guidance.
• Maintain relationships with Implementation Managers, Account Managers, and develop a cohesive cross functional, results driven working environment.
• Self-manage completion of work inventory in the production queues within established quality and turnaround time service levels.
• Coordinate and participate in cross-functional team activities for issue resolution.
• Recommend process and system enhancements to drive improvements.
• Support the management team with on-going training activities, misc. projects, resolving issues, and serving as a subject matter expert for all Configuration requests.

Requirements

• Associate's degree OR equivalent experience required.
• 5+ years of experience working within a core claims administration system.
• Good analytical and problem-solving skills.
• 2+ years of experience writing SQL queries and exporting data from database tables into Excel for analysis.
• Good communication and interpersonal skills.
• Ability to work independently or as a part of a team.
• Ability to manage multiple complex assignments at once.

Nice-to-haves

• 3+ years of experience in Operations in the Healthcare industry.
• Experience understanding claims adjudication for member and provider reimbursements.
• Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration.
• Knowledge of Medicare and Medicaid programs.