Claims Business Analyst
Job Summary:
Seeking strong Business Analyst to support BlueCard daily operations. This support will assist to move forward resolution of operational challenges, improve current processes and support project management initiatives. You will work closely with other team members and cross functional teams such as configuration and Account Management to resolve discrepancies and improve claims processing experience for BlueCard members
· Support the processing team with analysis of claim issues and inquiries. Perform root cause analysis and course correct identified issues for full resolution.
· Work with other plans to resolve issues for members
· Research root cause of incorrectly processed claims, failed DF and RFs. Provide solution and coordinate with appropriate team members to repair the claim and provide re-education to the processor or submit ticket for system enhancement.
· Focus on applying technologies to continuously increase claims process improvements with the use of data, Bots and applications/tools.
· Share this knowledge and skill with other team members to instill across the team the opportunities that they can escalate to process improve. Schedule reoccurring meetings to keep momentum.
· Responsible for evaluating current business processes and developing, implementing, testing and maintaining Technology for more cost effective or quality improvement processing.
· Assist with pulling needed data and assist with the documentation of processes and work procedures.
· Represent Department as SME in meetings, projects and company initiatives
· Communicate with other plans via the Blue Squared BCBSA Application (RTM)
- Advanced skills in Microsoft Office and with Microsoft platforms (e.g. Excel, Word, PowerPoint) is required; working experience with SQL and Access preferred. Experience with technologies, desktop tools and or Operations processes and technology is helpful
- Perform other duties as assigned.
Experience: 3 years or more of experience in medical claims processing and adjusting or healthcare administration. Expertise in the Blue Squared application
Technical Skills: Knowledge of medical billing codes (ICD-10, CPT, HCPCS), claims processing software, and a strong understanding of the BlueCard product. Ability to summarize large amounts of data and pivot data in multiple ways
Analytical Skills: Ability to assess claim data in detail and identify errors or inefficiencies. Possess excellent mathematical skills and have the ability to work independently and within tight timeframes.
Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders and resolving issues quickly
Attention to Detail: High level of accuracy and thoroughness in reviewing claims for clients
Inclusion and Belonging
At AmeriHealth Administrators, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
AmeriHealth Administrators is one of the largest national third-party administrators providing innovative, value-based health benefits programs and outsourcing services for self-funded health plans and other organizations.
The company also provides customized outsourcing services for TPAs and other payers, student health plans, and fully insured products.
AmeriHealth Administrators serves 1 million plan members in all 50 states and processes over 6 million claims annually.
Equal Employment Opportunity
AmeriHealth Administrators is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth Administrators employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth Administrators and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth Administrators or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.