Health Care Analyst

G-TECH Services - Detroit, MI

Full-time - Mid Level

Detroit, MI

Fabricated Metal Product Manufacturing

About the position

The Healthcare Analyst position is responsible for ensuring compliance with CMS requirements for Medicare Advantage plans, including PBM oversight and reporting. The role involves improving workflows, assisting with audits, and leading projects to enhance customer service and operational efficiency.

Responsibilities

• Develops and improves workflows and business processes to enhance customer service and reduce operational costs.
• Assists Customer Service with inquiries and communicates responses clearly.
• Supports CMS and internal audits by providing necessary data and documentation.
• Identifies business problems and devises procedures for effective solutions.
• Leads projects to achieve desired outcomes and communicates results to corporate stakeholders.
• Recommends and assists in implementing standard policies and procedures.
• Ensures ongoing communication and monitoring of corporate compliance.
• Participates in systems testing and provides recommendations for process improvements.
• Trains and assists internal and external personnel by answering questions and supplying information.
• Maintains effective working relationships with customers and participates in discussions.

Requirements

• Bachelor's degree in a related field preferred, or relevant combination of education and experience.
• Four years of experience in a related field, preferably in health plans or PBM.
• Proficiency in Microsoft Office applications, especially Excel, Word, and Outlook.
• Strong data analysis and problem resolution skills, including spreadsheet and database proficiency.
• Experience resolving eligibility and pharmacy claims issues.
• Experience responding to CMS requests regarding pharmacy claims.

Nice-to-haves

• Continuous learning mindset as defined by the company's learning philosophy.
• Experience with PBM systems and tools.