Benefits Analyst III - Doc Ops
Location : This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations and be willing to work Eastern Standard Time to meet the needs of our clients.
The Benefits Analyst III is responsible for identifying business needs and translating the needs into changes to the Evidence of Coverage booklet for our Large Group clients.
How you will make an impact:
- Designs and builds new standard and non-standard benefit plans, reviews and analyzes benefit summaries
- Identifies the best approach to code/develop benefits to achieve optimum adjudication levels
- Maintains avoidance of negative financial, regulatory, and operational impact. Performs testing and quality assurance of product developed
- Creates and maintains issue logs on the appropriate tool, resolve defects based on knowledge and analysis of system functionality
- Researches and responds to inquiries from various departments in a timely fashion
- Builds and enters custom benefit plans with the appropriate plan provisions and state mandates for various medical products
- Researches and responds to standard inquiries from various departments.
- Provides support with a focus on customer satisfaction.
- Demonstrates and applies an understanding of state mandates and the plan provisions contained in the certificate of insurance and Summary of Benefits and Coverage.
- Assists with quality audits
- May provide direction and guidance to team members and serves as an expert for the team.
Requires a BA/BS in a related field and a minimum of 3 years experience in claims processing, previous medical health care, analytical experience, or project management experience, or 5 years of benefit coding experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences
- Experience in healthcare insurance highly preferred
- Experience working with Salesforce and DocGen system highly preferred
- Experience working with Large and Small Group accounts highly preferred
- Experience working with the Evidence of Coverage booklet, Summary of Benefit and Coverage, and/or Summary of Benefits a plus
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World's Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.