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System Configuration Analyst, Dental Claims
Configure and test dental claims and utilization management systems at Liberty Dental Plan. The role focuses on benefit logic, claims rules, audits, and member notifications.
विवरण
- Manage claims and utilization management projects from coordination through completion.
- Review and process complex claims and utilization management cases.
- Help implement benefits and configure claims and utilization management systems.
- Work with cross-functional teams to build and maintain member notifications about claims and utilization management decisions and outcomes.
- Contribute to research and new business implementation projects as needed.
- Work with managers to develop, revise, and maintain departmental policies and procedures.
- Review and test existing system code rules, then recommend improvements.
- Test new and existing benefit configurations used in claims and utilization management adjudication.
- Assist with implementing Crystal Reports for claims and utilization management work.
- Carry out other assigned duties.
आवश्यकताएँ
- Bachelor’s degree.
- At least two years of experience in PPO or HMO claims processing, billing, or auditing.
- Proficiency with Microsoft Word, Excel, and Access.
- Strong written and spoken communication and presentation skills.
- Advanced analytical abilities, including data mining, reporting, and analysis.
- Sound judgment and logical reasoning, with the ability to communicate effectively in varied circumstances.
- Ability to manage multiple tasks efficiently amid interruptions or competing priorities.
- Knowledge of HSP systems.
- Knowledge of dental procedures.
- Knowledge of HSP denial explanations.
- Knowledge of service restrictions.
- Basic data analytics experience.
- Auditing experience preferred.
- Must be able to work in the United States.
- Visa sponsorship is not available at this time.
लाभ
- Competitive compensation structure and savings options.
- 401(k) plan with employer matching, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
- Affordable medical insurance, including low-cost employee-only premiums.
- Dental coverage for employees and eligible dependents paid in full by the company.
- Vision insurance with low-cost premiums for employees and dependents.
- Company-paid basic life and AD&D coverage equal to one year of base salary, with the option to buy additional coverage.
- Flexible Spending Accounts for healthcare and dependent care.
- Optional accident, critical illness, and hospital indemnity coverage.
- Long-term disability insurance.
- Wellness programs, including company-wide challenges, BurnAlong memberships, and gym discounts.
- Employee Assistance Program for mental health and well-being support.
- Generous vacation and sick leave, with the ability to carry over unused time.
- Ten paid company holidays.
- Tuition reimbursement for eligible education expenses.
- Remote or hybrid work options are available for various positions.
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