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Insurance Personnel Service - Southern Orange County, CA US
EMPLOYEE BENEFITS ANALYST IPS has an opportunity for a dynamic candidate with good technical knowledge of large group insurance plans to act as a liaison between ...
Insurance Personnel Service - Tri Valley Area, CA US
EMPLOYEE / GROUP BENEFITS ANALYST IPS has an immediate opportunity for a dynamic candidate to research and analyze group insurance plans and act as a liaison ...
Acting in the role of an individual contributor and/or project lead on mediumsize projects, this position is responsible for the following: * Analyze processes ...
WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide. WellPoint is the nation's ...
Analyzes and prepares claims from initiation to settlement. Liaisons with the insured, their agent and counsel and management to resolve claims. Prepares status ...
This position is the key analytic resource to support the design and development of bestinmarket Informatics reporting for Accounts. Specifically, this position ...
Date Updated: October 07, 2011 Language: English Travel: Not Specified Starting Date: December 1, 2011 Career Level: Mid Career (2+ years) Number Of Openings: ...
Job Title: Insurance Compliance Analyst II Area of Interest: Compliance City: Bellevue State/Province: Washington Job Description: Financial services is a highly ...
IT Technical Analyst; Function as a liaison between the IT organization and the business needs. Understand the information delivery related business needs and ...
HealthCare Insight® provides health care payors with a comprehensive suite of clinically validated fraud and abuse surveillance services to maximize claims administration accuracy and minimize payment waste. HealthCare Insight® is an equal opportunity employer.
Responsibilities:
* Complete daily suspect provider reviews by identifying suspect patterns, behaviors, and schemes utilizing analytical and work experience background. * Respond to client documentation review. When providing recommendations on clinical claims to the client: Does not interpret or evaluate clinical information but performs duties according to structured algorithms or other written guidelines. Licensed personnel provide oversight and follow-up for clinical related questions or issues such as the use of the algorithms or structured guidelines. * Assess and respond to client needs. * Monitor client acceptance rates and assist management in proactively detecting negative deviations. Participates on Quality Improvement Committee as required. * Identify inefficiencies and recommend changes to improve quality and streamline processes. * Identification and research of new and emerging fraud schemes.
Qualifications:
* Bachelor’s degree in an allied health or related field with a minimum of 5 years work experience in a medical office and/or managed care setting, or equivalent previous work experience. * Successful completion of Kenexa Prove It! skills assessment Medical Terminology test. Expected Professional Competencies: * Advanced knowledge of clinical procedures, conditions and treatment practices. * Experience analyzing and manipulating claims data, including knowledge of coding and insurance processes. * Intermediate to expert knowledge of key software applications (word processing, spreadsheets, database applications, email, etc), with strong ability to multitask and prioritize projects to meet scheduled deadlines. * Excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy. * Ability to analyze raw data and disseminate results.
