Claims Accounting Analyst

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Functions as the lead for the analysis and output functions of the accounting/technical unit with a specialized focus in Claims Accounting activities. Applies system analysis techniques to the processes for check run, GL, check reconciliation, abandoned property and all cost savings initiatives (hospice, pre and post payment audit reports). Provides vendor oversight by reconciling output, ensuring timely and secure file transfer protocol (FTP), maintaining vendor website functionality and supporting the business process outsource initiative. Leads efforts and applies system analysis techniques to the processes for check reconciliation, abandoned property, IRS tax levies and all cost savings initiatives (hospice, Medical Bill Audit, Cost Outlier review and pre / post payment audit reports). Leads Claims pre and post audit analysis activities; ensures accurate claims expense. Uses innovative approach to identify additional reviews / reports that may result in a higher level of accuracy. Writes/Runs new reports in Crystal or SQL. Creates and maintains complicated databases for Claims Accounting activities. Provides standard reports to Supervisor. Provides vendor oversight support for processes that are from other key operational areas.

• Bachelor's degree or an equivalent combination of education and experience from which comparable knowledge is achieved is required.
• 5 years of systems/operations experience in a managed care environment.
• Demonstrated expertise in analysis, system navigation, report production, EDI problem resolution.
• Proficient in Microsoft Word, Excel, Access, Crystal Reports or other reporting tool, Website and/or Web Portal Navigation, Amisys or other claims payment application.
• Claims accounting or finance methods helpful.
• Excellent oral and written communication skills.
• Excellent organizational, critical thinking and analytical skills.
• Ability to multitask and manage changing priorities.
• Technical experience or aptitude essential.
• Innovative 'think outside the box" thought process is preferred.