Claims Specialist from Innova Solutions

Innova Solutions is immediately hiring for a Benefit Analyst

Position type: Fulltime/Contract to Hire

Location: Philadelphia, PA 19103

Duration: 06 Months

As a Benefit Analyst you will:

Job Summary:

• Auditing Client Benefit Setup and Changes
• Performs comprehensive group setup audits to identify processor accuracy and/or compliance issues to ensure quality setup for clients
• Responsible for quality review of medical product/benefit accuracy, pharmacy, and other ancillary products.
• Oversee and review audit results from business vendor to ensure products are compliant with set up requirements and Client’s contracted benefits.
• Identify new audit areas by trend analysis or audit samples.

Responsibilities:

• Participate with Product teams and Sales in discussions regarding client benefits and setup.
• Identify trends and process improvement opportunities through audit findings. Collaborate with client setup team members, Sales and Product Management on discrepancies and errors to be corrected.    
• Conducts audits of client setup documents, including benefit templates. Responsible for client specific benefit template audits.
• Document audit findings, draft audit summaries and comprehensive audit reports and present to Sales.
• Audits Account Installation new business groups for in accordance with the established Underwriting guidelines.
• Audits client benefit changes, administration changes and cancelations in accordance with the established Client Set Up and Underwriting Guidelines.
• Must ensure necessary documentation is received, product information is accurate, and rates are confirmed before the group is approved or benefits changes are processed.
• Meet departmental production standards and quality requirements.
• Properly document and track assigned inventory.
• Respond to inquiries regarding departmental procedures/policies from Account Executives, Client Set up, Brokers, Enrollment and Billing.
• Triage and resolve issues related to group set-up and benefit changes.
• Handle errors and internal/external issues in a timely and effective manager to maintain turnaround times for completion o of customer/group set-up.
• Develop and maintain positive client relationships with internal and external customers and Account Executives.
• Participate in special projects regarding customer implementation and changes.
• Recommend process changes to increase departmental efficiency.
• Perform additional duties as assigned.

Education:

• Bachelor’s Degree preferred. In lieu of degree, must have 3-4 years relevant experience.

Requirement:

• Minimum 4 years relevant experience required; Audit experience preferred. Auditing, quality review or transaction processing experience required.
• Considerable knowledge of audit processes and requirements, including organization and storage of documentation. Well versed in best practice process and procedures.
• In-depth knowledge of healthcare products, benefits, and systems.
• Proven effectiveness in managing to project targets and deadlines. Demonstrated effective project management skills necessary.
• Must be able to work independently.
• Ability to audit client documents to ensure benefits and products are set up correctly.
• Flexibility and adaptability are a must.
• Willingness to be cross trained is required to assist other team members.
• Strong communications skills required – position interacts with all levels of management and may communicate with external clients as well.
• Excellent time management and organizational skills required.  Ability to prioritize workload and meet deadlines in a fast-paced environment without supervision.
• Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements and implementation are complying across operational disciplines.
• Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer.
• Ability to review and analyse data to identify patterns of incorrect benefit setup and benefit application of the setup in accordance with sound audit methods and practices.
• Must be strong problem-solver, be able to follow-up, and take an issue to resolution.
• Strong understanding of benefits and underwriting rating methodology.  Capability to understand Underwriting guidelines and apply them.
• Strong critical thinking skills.
• High level technical aptitude required - ability to use Microsoft Office and to learn proprietary and vendor systems. Demonstrated experience with Microsoft products (Word, Excel and Power Point.)

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.

We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW.

Thank you!

Prakash Bhagat

Sr. Associate – Recruitment

prakash.bhagat@innovasolutions.com

(+1) 678-831- 5493

PAY RANGE AND BENEFITS:

Pay Range*: $24.00 - $26.00 per hour.

*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

• One of Largest IT Consulting Staffing firms in the USA – Recognized as #4 by Staffing Industry Analysts (SIA 2022)
• ClearlyRated® Client Diamond Award Winner (2020)
• One of the Largest Certified MBE Companies in the NMSDC Network (2022)
• Advanced Tier Services partner with AWS and Gold with MS

Website: https://www.innovasolutions.com/

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any otherstatus protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.

The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.