Local to the office for hybrid is highly preferred, but would consider remote candidates in Columbus, OH, Salt Lake, UT, Houston, TX and Bloomington, MN. Must be in tristate (PA, NJ, DE) or within an hour of Columbus, OH, Salt Lake, UT, Houston, TX and Bloomington, MN to be eligible to convert.
6+ Months Candidates must have FEP Claims experience professional or facility and experience with claims quality assurance and auditing
Review FEP transactions to ensure accuracy of transaction and system processing. Provide timely documented feedback on issues identified at the processor and/or system level and execute escalation procedures if applicable. Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result. Ability/willingness to participate in departmental knowledge transfer activities to facilitate cross-training efforts. Actively represents the FEP Claims Team on various projects and possesses proven ability to identify required action items and impacts. Represent FEP Claims Team on assigned projects, providing feedback and assessing impacts accordingly. Identify FEP process improvements and develop workflow and/or system recommendations. Support lead analyst or supervisor in all project related activities (analysis, tracking, etc.) Develop and maintain FEP user documentation ensuring the most current information is available to the production areas. Communicate effectively in writing and verbally with in work groups and internal and external customers. Attend internal and external education training to achieve and maintain proficiency on all systems. Support assigned projects, maintain appropriate documentation at a task level, monitor deadlines and budget allocations and service as a technical liaison when appropriate. Assist with designing test plans and evaluate/ test new or modified processes and procedures to verify that the new programs or program changes are functioning as intended and conform to established policies. Maintain detailed testing notes, cases and outcomes to support all findings
Familiarity with FEP process flows, regulatory impacts and timelines to ensure requirements, testing and implementation are in compliance across operational disciplines. Proven experience assessing FEP regulations and required controls and incorporating what is required into the specifications and/or documentation. Proven ability to compile FEP detailed system requirements, reporting and data mining to support business needs that meet the need. Proficient in FEP trend analysis and communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer. Superior written and verbal communication skills are required to provide business units with FEP information and tools to support system modifications and/or new installations.
FEP Facility Claims Processing and adjustment experience FEP Facility Claims Quality and Audit experience Minimum of 5 to 8 years work related experience BS/BA Undergraduate degree or equivalent related experience
We offer a competitive compensation package that includes: Pay Rate: $35 - $38 per/hour W2 Note: Pay rate will be commensurate with experience. Medical for full time employees Dental, and Vision Insurance Life Insurance, Short-Term Disability, Long-Term Disability, etc.
Quality Business Analyst • Columbus, OH, United States
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