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Claims Process Analyst I/II/III
at Excellus New York in New York (Published at 13-04-2022)
Summary:
The Claims Process Analyst plays a primary role in the collection and analysis of division data, which are used to allocate current resources and estimate future requirements. Incumbents work hand in hand with unit management to analyze trends and make recommendations for process improvements, including preparing and implementing projects. This position is additionally responsible for analysis and feedback supporting staffing effectiveness, including formulation of business process strategies.
Essential Responsibilities/Accountabilities:
All Levels:
Level II- in addition to Level I Responsibilities:
Level III- in addition to Level II Responsibilities:
Minimum Qualifications
NOTE:
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All levels:
Level II- In addition to Level I Qualifications:
Level III- In addition to Level II Qualifications:
Physical Requirements
The Lifetime Healthcare Companies aim to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
The Claims Process Analyst plays a primary role in the collection and analysis of division data, which are used to allocate current resources and estimate future requirements. Incumbents work hand in hand with unit management to analyze trends and make recommendations for process improvements, including preparing and implementing projects. This position is additionally responsible for analysis and feedback supporting staffing effectiveness, including formulation of business process strategies.
Essential Responsibilities/Accountabilities:
All Levels:
- Provides advice and technical assistance in the preparation of division/unit production, processing, performance, and corporate metric analysis.
- Acts as a resource to the members of the group to ensure that new initiatives are both operational and implementable and align with our business.
- Plans, schedules, monitors, and reports on activities related to projects. Works with the team in determining customer requirements and translating requirements into operational plans.
- Collaborates with members of cross-functional teams to accomplish projects, meet established schedules, or resolve technical/operational issues.
- Fosters an environment of continuous improvement by constantly exploring ways to increase efficiencies and productivity, reducing waste, and reducing costs.
- Maintains knowledge of health insurance industry and company business, organizational policies, and organizational management structures and uses this knowledge to advise on and justify their current use.
- Advises on and provides justification for proposed requirements, strategic plans, and tactical plans, affecting business sponsors vision or initiative delivery.
- Directly negotiates with and functions as a liaison between functional partners, users, and suppliers.
- Directs analysis within the department for observations of processes and/or procedures to determine creative solutions or innovative approaches to process improvement strategies.
- Compiles and reviews performance data for assigned division, which is then reported for completeness, accuracy, and conformance with established procedures, State regulations, and organizational objectives.
- Trains and updates all end-user personnel for assigned division on appropriate procedures. Attends staff meetings for assigned division?s management team and front line staff as appropriate.
- Inputs data into files for assigned division and ensures that system data is timely and accurate. Develops forms, logs and information flows pursuant to operational areas studied. Publishes accurate weekly reporting for all assigned division teams. Develops and publishes reports detailing current operations, recommends changes and projects future needs.
- Conducts workflow analyses as requested. Analyzes proposed business systems or changes to project impact to operations. Identifies and suggests solutions in the processing system.
- Performs consulting duties that improve operational effectiveness at both intra-unit and inter-unit levels.
- Ensures that departmental practices comply with State and Federal laws.
- Ensures the development and adherence to corporate, divisional and departmental policies, standards and procedures.
- Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies? mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
- Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
- Regular and reliable attendance is expected and required.
- Performs other functions as assigned by management.
Level II- in addition to Level I Responsibilities:
- Acts as subject matter expert for internal and external personnel for complex claims related issues.
- Conducts analyses on complex operational issues, often affecting multiple areas and functions.
- Recommends changes and solutions to issues or more efficient methods and processes.
- Upon management approval, drives changes and implements solutions.
- Acts as internal subject matter expert for claims related matters.
- Identifies root causes of business and/or workflow problems and determines innovative sources for solutions and opportunities.
- Represents Managers in matters and attends Corporate and regional committees, meetings and workgroups.
- Proposes business strategies and meets process improvement goals set by the Corporation each year.
- Guides and mentors Implementation project management team and fosters positive attitudes among staff on quality and safety to ensure that delivered service meets agreed service levels.
Level III- in addition to Level II Responsibilities:
- Conducts highly complex, systemic analyses, utilizing both internal and external resources.
- Independently proposes changes and improvements to current systems and processes.
- Independently drives changes and implements solutions.
- Manages change projects to effective completion
- Acts as project team leader with matrixed management.
Minimum Qualifications
NOTE:
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All levels:
- Associate?s degree in Business Administration, Healthcare, or other relevant discipline and 1 year of progressive experience in an analytical role. In lieu of degree, 4 years of relevant experience in a health insurance environment, 1 of which has emphasis on process improvement or analytical function required.
- Must be flexible and have a working knowledge of all department functions.
- Writes and speaks fluently on all aspects of work. Communicates effectively with users/customers, and colleagues 2-3 levels up/down and across a range of disciplines, and all levels of management.
- Ability to multi-task.
- Microsoft office experience required. Must be proficient with Word/Excel, working knowledge of Access/PowerPoint.
- Able to gather necessary information and perform analysis on this data. Able to analyze information and present results clearly to higher levels of management.
- Demonstrate the ability to identify root causes of business and/or workflow problems and determine innovative sources for solutions and opportunities.
- Must be able to propose business strategies to assist in meeting the process improvement goals set by the Corporation each year.
- Ability to work well with all levels of Management.
Level II- In addition to Level I Qualifications:
- Associate?s degree in Business Administration, Healthcare, or other relevant discipline and 3 years of progressive experience in an analytical role. In lieu of degree, 6 years of relevant experience in a health insurance environment, 3 of which have emphases on process improvement or analytical function required.
- Advanced ability to multi-task.
- Expert at identifying root causes of business and/or workflow problems and determine innovative sources for solutions and opportunities.
- Master at multi-tasking and prioritization of workload.
- Represents Managers and Directors in all matters including decision-making responsibilities, attendance at Corporate and regional committees, meetings and workgroups.
- Expert at proposing business strategies and meeting process improvement goals set by the Corporation each year.
- Can act as Project Manager, and collaborate with other areas to accomplish key objectives
- Effective oral and written communication skills. Be a well-rounded candidate with strong creative, leadership, and team building skills.
- Analytical abilities from both a data and process review focus will be critical. Able to recommend improvements to current processes
- Expert knowledge of Operations and understanding of its operating teams and their functions
Level III- In addition to Level II Qualifications:
- Associate?s degree in Business Administration, Healthcare, or other relevant discipline and 5 years of progressive experience in an analytical role. In lieu of degree, 8 years of relevant experience in health insurance environment, 5 of which have emphases on process improvement or analytical function required.
- Project management experience preferred.
- Demonstrated ability to manage projects across matrixed teams.
- Ability to liaise with technical industry in a meaningful manner.
Physical Requirements
- Use of a computer and phone
- The ability to travel across all regions of the Health Plan
The Lifetime Healthcare Companies aim to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer