Claims Coordinator

Minnesota  ‐ Onsite
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Keywords

Description

Claims Coordinator

Job Summary. (In three or four sentences summarize the job's purpose and primary focus.)

Analyst is responsible for the management and maintenance of Benefit configuration in the BETS, HealthConnect, KMATE, and Diamond Claims system to support accurate and timely payment or adjudication of claims, benefit administration (such as: Member out of pocket maximums) and EOC production and generation.

Major Responsibilities/Essential Functions.
(In order of importance, list primary job duties this position is responsible for achieving. Each statement should relate to an end result or objective.) Estimated % of Time Spent

Ensures benefit information is translated from source documents to the BETS system so accurate benefit configuration is available in supporting systems

Ensures configuration accuracy meets or exceeds Regional metrics

Is responsible for maintaining integrity of BETS, HealthConnect, KMATE, DIAMOND benefit information and other systems as applicable.

Ensures benefit configuration meets established business rules and procedures

Develops and executes test plans for configuration testing, reports on outcome

Acts as liaison between Contract Benefit Configuration and other departments regarding system configuration and functionality

Modifies the systems: BETS, HealthConnect, KMATE, DIAMOND, and other systems as applicable configuration to reflect source documentation.

Ensures that deliverables produced meet quality, cost, and turnaround metrics 5

Consults with relevant department to determine appropriate interpretation and configuration of benefit information

Ensures effective coordination of work activities and objectives with others

As Needed

Validates that the completion of administrative requirements is met in a timely and accurate mannerAs Needed

Maintains detailed knowledge and understanding of benefit configuration in all systems As Needed

Performs problem resolution of configuration issues As Needed

Escalates concerns, issues or discrepancies to management team

As Needed

Responsible for peer-to-peer quality assurance support and oversight As Needed

Job Qualifications.

Minimum Education (Indicate minimum education or degree required.)

Bachelor's Degree, preferably in Health Care Administration, Business Administration or a Health Profession, or equivalent (Additional four years) combination of education and work experience in healthcare, preferably in an HMO setting is required.

Preferred Education (Indicate preferred education or degree required.)

Minimum Work Experience and Qualifications (Indicate minimum years of job experience, skills or abilities required for the job.)

Four years experience including statistical analysis in measurement, report design, and auditing production is required.

Other

Working knowledge of KMATE, BETS, DIAMOND, KPHC configurations

Work as a project team member as Subject Matter Expert (SME) is required.

Understanding of detailed spreadsheet knowledge is required.

Excellent communications and technical writing skills are required.

Personal computer literary is required.

Ability to work in MS Project is required.

MS Office experience is required.

Preferred Work Experience and Qualifications (Indicate preferred years of job experience, skills or abilities required for the job.)

Project Management experience is preferred.

Start date
n.a
From
Enclipse Corp.
Published at
31.05.2012
Project ID:
370810
Contract type
Freelance
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