Lincoln, RI 02865
- In this role, you will analyze client benefit requests, determine best operational approach, and perform coding.
- You will validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction.
- In addition, this position is responsible for meeting or exceeding turnaround time and quality standards.
- You will be researching client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs.
- In addition to coding, this position will also be responsible performing QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines.
- This position may support coding and QA activities for commercial clients as well as clients with federal/state programs (such as Medicare D, Medicaid, MAPD, RDS, COB, EGWP, HealthCare Reform, etc.).
- 2+ years of professional work experience in Claims, Insurance, QA, Testing, or a high-production environment.
- Previous work experience in a PBM, Medical Claims, Health Insurance, Pharmacy, or Benefits highly preferred.
- Well organized with the ability to effectively prioritize work.
- Ownership and results driven.
- Customer focused.
- Attention to detail.
- Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality.
- Proficient use Microsoft Office applications, e.G. Excel, Word.
- Ability to effectively work within a team.
- Flexible in adapting to change.
- Demonstrated ability to analyze data and determine conclusions.
- Ability to learn and apply increasingly complex concepts, policies and procedures.
- Ability to effectively plan, prioritize, organize time and workload.
- Skilled in identifying and solving issues and recommending process improvements.
- Ability to work successfully in a deadline-oriented environment.
- Excellent verbal and written communication skills.
- Project Management skills.
- High School Diploma/GED required Bachelor's degree preferred.
For more information on this position, please contact our office at 877-782-3334.