- Work with regulatory agencies, clients, and external parties during the external audit process.
- Coordinate, track, and complete Claim / UM projects.
- Analyze and process complex Claim / UM scenarios.
- Assist with benefit implementation and claims configuration.
- Work with QM and IT to implement and maintain member EOB's and member and provider pre- estimate compliant templates.
- Provide assistance as needed with research projects and new business implementation.
- Work with management to create and maintain department policies and procedures.
- Coordinate with UM staff in identifying and creating code rules in system for claims processing.
- Audit and test existing code rules and be able to make recommendations for improvement.
- Audit and test new and existing benefit set ups as they apply to claim adjudication.
- Proficiency with Microsoft Office tools (Word, Excel, Outlook, and SharePoint).
- Please be prepared to Complete an Online Skills Assessment as part of the Application process
- Strong written and verbal communication and presentation skills.
- Advanced analytical skills for data-mining, reporting and analysis.
- Bachelors Degree or equivalent combination of education and experience, required.
- Minimum 2 years' experience in PPO and HMO claims processing, billing, and/or auditing required.
- Prior auditing experience preferred.
- Competitive pay structure and saving options that help you reach your financial goals
- Excellent 401k retirement benefits available which includes employer match and ability to save via a Roth IRA, plus immediate vesting during Safe Harbor period and professional financial advice through Financial Engines
- Medical insurance offered with low-cost premium for employee only coverage and LIBERTY subsidizes 50% of dependent coverage for eligible enrolled dependents.
- 100% employer paid dental coverage for employees and eligible dependents.
- 100% employer paid vision coverage for employee only coverage, low-cost premium for dependents
- Company paid basic life and AD&D coverage; options to elect additional supplemental coverage.
- Long Term Disability coverage
- Expansive wellness program including companywide Get Active challenges and Burn-A-Long with option for gym discounts.
- Employee Assistance Program
- Generous vacation and sick leave with the ability to roll time over.
- 10 paid company holidays
- Tuition Reimbursement
- Remote or Hybrid options for various positions
- And so much more...
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System Configuration Analyst - Tustin, United States - Liberty Dental
Description
Job DetailsJob Location
LIBERTY Dental Plan Corp. - Tustin, CA
Remote Type
Fully Remote
Position Type
Full Time
Job Shift
Day
Job Summary
Tooth be told... you will love working with us
The System Configuration Analyst collaborates with the claims management, QM, Compliance, and IT teams to coordinate and prepare external audits, set up and test claim system configuration, complete claim-related special projects, handle Crystal Report implementation, and work with management to provide accountability and business direction for the Claims / Utilization Management (UM) Departments.
Key Responsibilities:
Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.
What LIBERTY Offers:
Happy, healthy employees enhance our ability to assist our members and contribute more actively to their society. That's why LIBERTY offers competitive and attractive benefit packages for their employees. We strive to care for employees in positive ways that promotes wellness and productive employees.
Our first-class benefit package supports our employees and their dependents with:
In the spirit of pay transparency, we are excited to share the base salary for this position is $58,760 - $76,388, exclusive of fringe benefits or potential bonuses. If you are hired at LIBERTY, your final base salary compensation will be determined based on factors such as geographic location, skills, education, and/or experience. In addition to those factors - we believe in the importance of pay equity and consider internal equity of our current team members as a part of any, final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical in order to allow for future & continued salary growth.
LIBERTY Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. LIBERTY will leverage diverse perspectives in building high performance teams and organizational culture.
LIBERTYDental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.
We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.
Sponsorship and Relocation Specifications:
LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.
No relocation assistance or sponsorship available at this time.
