Easter Seals Jobs

Reference #: 1100498 Sr. Client Setup Quality Analyst-HYBRID to Philadelphia PA

Category:    Healthcare & Medical

Employment Type:    Contract To Hire

Reference:     BH-380741

Send updated resumes to Tymir Black https://www.linkedin.com/in/tymir-black-035914111/ Tymir.Black@yoh.com

Sr. Client Setup Quality Analyst Job Summary -  Minimum 4 years relevant experience required; Benefits and Claims experience preferred. Auditing and quality review experience required. * Experience with HealthRules Manager/Designer preferred. * Participates in pre and post implementation audits of client benefits and setup. * Prepares accurate and complete claims test scenarios. * Performs comprehensive group setup audits to validate setup accuracy and/or compliance issues to ensure quality setup for clients. * Responsible for reviewing claims and systems to validate benefit setup accuracy for Medical products including Ancillary Setup as required. * Effectively document and review audit results to ensure benefits are compliant with set up requirements and Client's contracted benefits. * Assist Configuration team with building of benefit plans.

Responsibilities * Participate in internal and external audits. * Work with Client implementation, Sales and Audit teams to understand scope and timeline to audit client benefits and setup. * Identify setup issues, trends and process improvement opportunities through audit findings. Collaborate with client setup team members, Sales and Product Management on discrepancies and errors to be corrected. * Conducts audits of client setup documents, including benefit templates. Responsible for client specific benefit template audits. * Effectively document and communicate audit findings, audit summaries and comprehensive audit reports and present to Audit and Sales. * Audits client benefit changes, administration changes and cancelations in accordance with the established Client Set Up and Underwriting Guidelines. * Must ensure necessary documentation is received, product information is accurate, and rates are confirmed before the group is approved or benefits changes are processed. * Meet departmental production standards and quality requirements. * Properly document and track assigned inventory. * Respond to inquiries regarding departmental procedures/policies from Account Executives, Client Set up, Brokers, Enrollment and Billing. * Triage and resolve issues related to group set-up and benefit changes. * Handle errors and internal/external issues in a timely and effective manager to maintain turnaround times for completion o of customer/group set-up. * Develop and maintain positive client relationships with internal and external customers and Account Executives. * Participate in special projects regarding customer implementation and changes. * Recommend process changes to increase departmental efficiency. * Perform additional duties as assigned.

Qualifications: Education * Bachelor's Degree preferred. In lieu of degree, must have 3-4 years relevant experience. Experience * Minimum 4 years relevant experience required; Benefits and Claims experience preferred. Auditing and quality review experience required. * Experience with HealthRules Manager/Designer preferred. Knowledge, Skills, Abilities * Considerable knowledge of audit processes and requirements, including organization and storage of documentation. Well versed in best practice process and procedures. * In-depth knowledge of healthcare products, benefits, and systems. * Proven effectiveness in managing to project targets and deadlines. Demonstrated effective project management skills necessary. * Must be able to work independently. * Ability to audit client documents to ensure benefits and products are set up correctly. * Flexibility and adaptability are a must. * Willingness to be cross trained is required to assist other team members. * Strong communications skills required - position in eracts with all levels of management and may communicate with external clients as well. * Excellent time management and organizational skills required. Ability to prioritize workload and meet deadlines in a fast-paced environment without supervision. * Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements and implementation are complying across operational disciplines. * Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer. Ability to review and analyze data to identify patterns of incorrect benefit setup and benefit application of the setup in accordance with sound audit methods and practices. * Must be strong problem-solver and be able to follow-up and take an issue to resolution. * Strong understanding of benefits and underwriting rating methodology. Capability to understand Underwriting guidelines and apply them. * Strong critical thinking skills. * Proficiency with HealthEdge applications (HealthRules) or some other benefits/claims processing software * High level technical aptitude required - ability to use Microsoft Office and to learn proprietary and vendor systems. Demonstrated experience with Microsoft products (Word, Excel and Power Point.)

Note: Any pay ranges displayed are estimations.  Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description.  All qualified applicants are welcome to apply.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Visit  https://www.yoh.com/applicants-with-disabilities      to contact us if you are an individual with a disability and require accommodation in the application process.

For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.  All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.