Benefits Analyst 1

Job Description

Job Description

TITLE

Benefits Analyst I

POSITION SUMMARY

The Benefits Analyst I is responsible for supporting all aspects of benefit configuration from programming, reviewing, and auditing benefit configuration to ensuring that all benefits are programmed accurately for Authorizations and Claims.

RESPONSIBILITIES-DUTIES

• Knowledgeable of Health Plan web sites to obtain benefits information for members.
• Able to contact Health Plans by phone to verify members benefits.
• Understand to check Eligibility at the same time while verifying benefits.
• Coordinates with Benefits team to provide standards to follow and performs random audits.
• Communicate and document findings internally with Benefits team.
• Ensure all systems are responsibility, reliable, responsive and support to the needs of all IPAs of AMM
• Communicates, monitors and audits processes and procedures necessary to achieve strategic objectives.
• Create and Maintain Option Masters for each benefit option provided by the Health Plan by LOB. This module houses the financial responsibility table number, Out of Pocket Maximums and Deductibles
• Develops and implements data integrity initiatives for benefits configuration and any other areas that support the effective operation of internal systems.
• Coordinates, document and development projects - Must be highly organized.
• Assists and support different department inquiry with emails, answering phone calls and call health plans to verified information.
• Provides daily oversight of benefits.
• Input and update benefits for all Health plans and all IPAs’ lines of business.
• Responsible for adding options in EzCap for Eligibility Department daily.
• Program, review and update benefits in EzCap on a daily basis
• Assist in downloading Benefits Online
• Runs reports to find benefit discrepancies.
• Assist and recommend in the development of process improvements including policies and procedures
• Assist with training and supporting AMM team.
• Able to respond to emails in a timely manner and provide support
• Coordinating with various departments to resolve benefits inquiries or any system related issues
• Good judgments to plan and accomplish goals
• Performs variety of different tasks
• Administers and ensures timely completion of all projects
• Other duties may be assigned as needed to assist by Lead or Manager

EDUCATION & EXPERIENCE REQUIREMENTS

• College Degree preferred,
• Experience with benefits configuration and interpretation
• Individual should also demonstrate the ability to work with all levels within AMM
• Must be highly organized and able to perform multiple tasks efficiently, be computer literate and must be very knowledgeable of benefits
• Knowledge of software applications such as EZCAP is a plus
• Must be familiar with Microsoft Office (Word, Excel, Outlook, Microsoft, Access)
• Follow up on assignments, show initiative, be self-motivated, and have a strong work ethic
• Possess strong time management skills, including the ability to prioritize deadlines on multiple projects
• Produce accurate and high-quality work on time and consistently
• Ability to work in a fast-paced environment
• Strong analytical skills and problem solving skills are necessary
• Must obtain a positive attitude and have excellent communication skills
• Ability to work independently and within a team

A desire to contribute to company culture and innovation. This individual must also obtain the drive to succeed and flourish within our organization.

The majority of our supervisory and management team have been promoted from within and it is our goal to continue the professional growth of every team member.

This is an excellent opportunity for someone seeking a career transition with massive growth potential in the health care industry.