What are the responsibilities and job description for the Operations Specialist | Contract-to-hire, W2 | Philadelphia PA 19103 40% Remote position at Alpha Business Solutions LLC?
Job Details
Our direct client a large healthcare insurance provider is seeking to hire for the position of Operations Specialist - Health Insurance . This is a contact-to-hire role.
Job Title: Operations Specialist
Location: Philadelphia PA 19103 (three days/week onsite)
Duration: 3 months contract-to-hire. This will start as contract and convert to full-time at end of 3 months.
Team does reconciliation between medical and RX claims. Sharing with pharmacy vendor partners.
Thank you,
Ashu
Job Title: Operations Specialist
Location: Philadelphia PA 19103 (three days/week onsite)
Duration: 3 months contract-to-hire. This will start as contract and convert to full-time at end of 3 months.
Team does reconciliation between medical and RX claims. Sharing with pharmacy vendor partners.
- Two candidates who have a business knowledge of health insurance and the tech side Experience in Microsoft suite- Microsoft excel (VLOOKUP s, Pivot tables) and SQL Server
- Auditing experience a plus.
- Day to Day: Tickets are a part of the process- calls come in from members/brokers/or the whole group.
- Proactively monitor some of the accumulators that are coming in. Someone who can help assist in improving the process- when it comes to tracking between the team and other vendors.
- Able to assess the whole picture and help the team figure out how to better solve issues. Monitoring file feeds.
- Health rules and Health proof a lot and checking against inhouse systems.
- Auditing, analyzing, testing, documenting decisions and actions, and interfacing with internal and external areas from inception to conclusion for assigned projects and tasks.
- Identify & communicate opportunities for process improvements and automation by analyzing current policies, procedures, and processes.
- Troubleshooting & problem resolution support for issues related to internal & external audits, adjustments, and accumulators, engaging subject matter experts, as needed.
- Makes decisions based on standard policies and operating procedures.
- Consults with management and obtains approval before deviating from standard policies and operating procedures.
- Demonstrates strong organizational, analytical, and interpersonal skills with detail-oriented focus.
- Demonstrates computer proficiency, including but not limited to, Microsoft Suite - Excel, Outlook, SQL Server Management Studio.
- Demonstrates MS Excel proficiency with the ability to create formulas, v-lookups, pivot tables and analyze data.
- Proactively monitor and analyze claim and accumulator transaction activity for quality, accuracy, mapping issues, and adherence to regulatory compliance requirements and performance standards.
- Monitor system health throughout the day, supporting real-time transactions.
- Identify data for potential areas of failure and work on long-term solutions.
- Act as a liaison between other departments and delegates related to internal/external audits, member/group complaints raised, etc.
- Create accurate claims reporting for internal and external customers.
- Collaborate effectively and build solid working relationships with internal customers, cross-functional internal departments, external vendor partners, and clients.
- Coordinate with Trading Partners and Account personnel to resolve claim and accumulator issues.
- Provide business validation of testing results related to claims reporting, encounter data files, accumulator files.
- Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows.
- Implement temporary fix to resolve accumulator issues while also collaborating on a permanent fix.
- Bachelor of Science in Accounting, Computer Science, Information Systems, or Information Technology preferred.
Thank you,
Ashu
- Medical for full time employees
- Dental, and Vision Insurance
- Life Insurance, Short-Term Disability, Long-Term Disability, etc.
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