Claims Operations Analyst

IntePros is searching for a Claims Operations Analyst for our leading Healthcare client in Center City Philadelphia! The Analyst works in a production environment handling transactions required as well as business support to teams as needed.Handle claims production tasks such as written inquiries and reconsiderations and related adjustments to attain FEP Performance metrics.Ability to assess FEP procedures and regulations and required controls and incorporating what is required into the specifications andor documentation.Identify process improvements and develop workflow andor system recommendations.Support FEP audits, including research claims related issuesquestions and preparation of appropriate audit responses as well as represent the organization in the audit presentation to FEP Directors Office, BCBSA, if needed.Support assigned projects related to FEP, maintain appropriate documentations at a task level, monitor deadlines and service as subject matter expert when appropriate.Develop and maintain user documentationdesk level procedures ensuring the most current information is available to the claims team.Work with the Business Support team in reviewing FEP release documentation and participate in testing initiatives as municate effectively in writing and verbally in work groups and with internal and external customers.Attend internal and external education training to achieve and maintain proficiency on all systems.Requirements:High School Diploma or GED ,4 years' experience in a ClaimsService operations environment OR Associate degree or minimum two-year Federal Employee Health Benefits Plan work-related experience, bachelor's degree preferred.Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements, testing and implementation are in compliance across operational disciplines.Excellent written and verbal communication skills are required to provide business units with information.Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result.Experience in auditing, quality review or transaction processing experience.Demonstrated understanding of FEP policies, processing standards and guidelines.

Created: 2024-10-19