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Plan Benefit Analyst - Remote Opportunity

Company: S'S Healthcare
Location: Cincinnati
Posted on: August 6, 2022

Job Description:

S Health is a premier healthcare administration company located in Cincinnati, Ohio. We offer self, level and fully funded solutions that lower costs while improving outcomes with a consumer centric experience. Our integrated benefits, services and technology platform have been developed to serve the needs of Employers, TPAs, and Health Systems. The company has a nationwide presence with the ability to sell and service in every state.The Plan Benefit Analyst builds medical, dental, vision, and other benefit plans of clients into our claims processing system. They are responsible for building and maintaining the claims system to ensure appropriate claims adjudication.Responsibilities: Programs health medical, dental, vision, and other benefit plans into the claims system to accurately adjudicate benefits.Inputs medical, dental, vision, and other plan design modifications and enhancements and verifies accuracy of output. Handles technical inquiries related to provider contracts, billing, and plan benefits.Communicates status of new accounts, renewals, and amendments.Ensures the financial accuracy of claims payment.Reviews "Summary Plan Documents" with appropriate team members.Responsible for accurately maintaining and updating plan benefit changes and serves as a main point of contact for all benefit customizations and issue resolution as it relates to plan benefits. Working knowledge of current HIPAA and Affordable Care Act laws.Acts as a consultant to product development on how to implement and execute innovative products. Practice root cause analysis to better overall processes, implications and problem resolution. All other duties as assigned.Minimum Qualifications:Strong ability to understand Plan Documents and medical plan benefits.Strong ability to know how each medical plan benefit should pay. Strong math and analytical skills.Excellent verbal and written communication skills. Ability to organize and manage multiple tasks. Strong logical thinking capability. Solid claims background.Computer proficiency. Must be organized and detail oriented. Exceptionally detail oriented.Excellent problem-solving abilities.A team player, flexible in the context of change.Able to handle confidential information.Demonstrated ability in prioritizing and handle multiple projectsEDUCATION/EXPERIENCE 1-3 years' experience working in healthcare TPA environment in Plan Building and/or Claims environment. High School diploma or GED with experience in medical insurance or managed care.Post high school education is preferred.

Keywords: S'S Healthcare, Cincinnati , Plan Benefit Analyst - Remote Opportunity, Professions , Cincinnati, Ohio

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