• Workforce Claims Analyst

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5087
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    This position is responsible for developing an extensive expertise in the overall functionality of the Virginia Premier Claim’s processes and payment systems.  This position requires eye for detail, database knowledge and experience, ability to create data models, critical thinking and proven ability to be a problem solver.  Ability to learn various software skills in order to support end-user operations is critical for this role. 

    Responsibilities

    • Monitor, organize the claims inventory, and ensure that the claims inventory is compliant with CMS and all other regulatory and governing bodies compliance guidelines; 
    • Gather and review information related to staff performance and customer issues; 
    • Determine ways to improve claims operations and workflow through effective staffing decisions so that departmental operational needs are met; 
    • A major duty,  will be to involves assessing staffing levels on a daily basis; 
    • Workforce analysts may also create, develop and produce reports for the Claims department, as needed; 
    • Analyze the same reports to determine if employees are being utilized effectively or/to develop strategies to recruit additional resources and/or qualified staff;   
    • The workforce analyst will play a direct role in ensuring that company policies and processes are adhered to; 
    • Produce Standard Weekly and Monthly Reports; 
    • Assist in System Setup and Analysis; 
    • Perform Analysis/Auditing on High-Dollar Claims and High-Volume Claims; 
    • Assist in creation and analysis of Claims Operational trends; 
    • Ensure all codes, fee tables, and updates are current and loaded correctly;     
    • Support Claims System Manager on technical issues and/or projects;
    • Other duties as needed; 

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor’s Degree in Business, Mathematics, or Information Systems

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Proficient knowledge of SQL queries to include ability to create and populate databases, perform data normalization, create query analysis, conduct table indexing, performing multiple table joins, and comfortable usage of functions (average, count, max, min, etc.)
    • Proficient knowledge of Microsoft Excel to include comfortably utilizing functions, developing charts and graphs, inserting formulas, performing VLOOKUP, and sorting and filtering data
    • Previous Computer Software and or Hardware experience;
    • Proven ability to analyze data;
    • Demonstrated experience in developing analysis queries;
    • Experience in use of information system resources;
    • Previous Claim Processing Experience a plus;
    • Leadership, communication and organizational skills;
    • Pays attention to detail with very strong analytical skills. 

    WORK BACKGROUND/EXPERIENCE

    • Minimum of one year experience with end-user or system support
    • At least one year in data analysis, programming or business analysis 

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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