Job Description
It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
The Internal Controls/ Operational Financial Analyst's role is to work with the VP Finance and others to strengthen the internal controls of the organization as it relates to core process flows. The Analyst will dissect enrollment, claim and other data and work with operational and finance teams as needed to reconcile information between WellSense systems and contract holder systems. He/she will also support the Accounting Dept in its monthly close process providing data as needed. He/she will also work with IT to address needed maintenance and workflow changes. This individual's code may be the basis of configuring IT processes to address/ correct information flow. The Analyst will work with operational and financial teams, to design processes to meet the requirements of complementary controls. Dashboards will be created to measure progress for all specified areas. The Analyst will closely interact and collaborate with the Plan's Enrollment, Claim Applications, IT and other Finance teams to create and refine workflows. The Analyst should have advanced data mining skills and have a "roll up your sleeves" mentality.
Our Investment in You:
•Full-time remote work
•Competitive salaries
•Excellent benefits
Key Functions/Responsibilities:
•Applies specialized technical and analytic skill to produce analyses, reports, and applications to reconcile data issues.
•Uses SAS and/or SQL coding to pull claims and membership data, has ability to join information obtained from various data tables.
•Monthly works with the Enrollment Dept and others to identify discrepancies to be investigated and fixed or addressed, if applicable.
•Serves as data expert for department.
•Works with Accounting team to provide key reports to assist with each month end close (revenue reporting for certain lines of business as an example.)
•Works collaboratively to reconcile claim invoice totals to claim files absorbed by the data warehouse on a monthly basis.
•Works with Claims Operations Analyst to provide reports to assist with identification of claim issues or activity that will drive monthly journal entries.
•Advises Finance department on data warehouse design requests and works with IT to establish priorities.
•Works with VP Finance with goal to move towards a control based external audit versus a substantive audit in certain areas.
•Participates and leads workgroup sessions, applies business experience and analytical skills to assist in creating controls around critical Plan processes and workflows.
•Assists in the investigative work to identify and evaluate business process risks and controls
•Defines recommendations and improves processes in collaboration with operational teams.
•Works with Departments to create controls and workflows to ensure business processes function as needed. Expected to interact with various departments within the organization such as Applications, Quality, Enrollment, Claims, Provider Maintenance, Business Intelligence Departments as well as Finance and Actuarial.
•Communicates control gaps and present recommendations to management in clear and concise fashion
•Manages follow-up of recommendations and expected management action plans with business process owners to ensure timely closure and remediation of identified weaknesses relating to internal controls and existing processes
•Effectively communicates with external auditors in support of WellSense initiatives and requirements. •Assists VP Finance in obtaining information to support various audit requests and reconciliations
•Responsible for ad hoc analytics as necessary.
•Develops operational dashboards to monitor improvement or gaps that arise on a monthly basis.
•Regular and reliable attendance is an essential function of the position.
•Demonstrates support of WellSense mission and values
Supervision Exercised:

• May provide technical support to less experienced staff.

Supervision Received:

• Direct Supervision received weekly

Qualifications:
Education Required:
•Bachelor's degree in Analytics or related field required.
•A background in managed healthcare, insurance operations preferred Certification or Conditions of Employment
Experience Required:
•2-4 years related experience in data modeling, informatics and analysis with demonstrated capacity to independently draw inferences and to communicate findings. Commensurate educational experience in a related field will be considered.
Required Licensure, Certification or Conditions of Employment:
•Successful completion of pre-employment background check
Competencies, Skills, and Attributes:
•Experience working in a team-oriented, collaborative environment
•Should be proficient in Microsoft Excel, SAS/SQL
•Must be able to analyze current business processes, define new ways of doing business and document clear recommendation for change.
•Excellent analytical and creative problem-solving skills.
•Excellent written and oral communication skills.
•Excellent listening and interpersonal skills.
•Logical and efficient.
•Keen attention to detail.
•Ability to communicate ideas in both technical and user-friendly language.
•Highly self-motivated and directed.
•Ability to effectively prioritize and execute tasks in a high-pressure environment.
•Ability to successfully plan, organize and manage operational audit projects
•Analytical skills and ability to assess risks and controls
•Strong oral and written communication skills; ability to interact within all levels of the organization
•Ability to organize and prioritize multiple tasks and assignments in order to meet deadlines
•Interpersonal skills, including the ability to influence others and establish credibility with business partners
•Strong work ethic, initiative, teamwork, and flexibility to assist department in meeting organizational goals
Working Conditions and Physical Effort:
•Remote workforce with periodic in person meetings at corporate office
•Ability to work overtime during peak periods.
•No, or limited, physical effort required. Limited, exposure to physical risk.
•Regular and reliable attendance is an essential function of the position.
•Work is normally performed in a typical interior/office work environment.
•No or very limited physical effort required. No or very limited exposure to physical risk.
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees