Healthcare Analyst

JOB RESPONSIBILITIES:

Conduct comprehensive audits on group members to evaluate their health insurance coverage, encompassing medical, dental, vision, and hearing benefits.

Integrate modified membership information into the database to ensure it is up to date and accurate.

Handle inquiries from groups regarding member healthcare coverage in a comprehensive manner.

Confirm the eligibility of members and ensure that their coverage is within the appropriate time frame of the group.

Verify that members in the internal systems align with the members listed in the group files.

Investigate any discrepancies between coverage in the system and actual coverage of a member and determine the appropriate course of action.

Confirm the eligibility of members by verifying that their provider/primary care physician (PCP) information matches that in the system. Verify that the PCP selected by the member is eligible to be a provider by checking the system using their National Provider Identifier (NPI).

REQUIRED SKILLS:

-At least 1 year of solid experience in US Healthcare Insurance.

-Good Analytical and Problem-Solving skills

-Good Verbal & written communication skills

-Microsoft Office experience (intermediate to advanced experience) including Excel/Access/SharePoint/Outlook/Word

-Ability to lead & contribute to process improvement programs.

PREFERRED SKILLS:

Healthcare knowledge

Membership enrollment experience

EDI 834 experience

Leadership experience