Claims Process Oversight Analyst (Health Care Vendor Management)
EmblemHealth
New York, New York
oversight
analyst
health
vendor management
management
mass
oversight
drive
system enhancements
delivery
configuration
operations
collaborate
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November 19, 2022
EmblemHealth
New York, New York
- Provide direct oversight over the Cognizant vendor for all recycle activities.
- Monitor the mass adjustment/recycle program.
- Drive necessary system enhancements & improvements for the mass adjustment/recycle program.
- May provide process improvement recommendations.
- Accountable for oversight of Cognizant Mass Claims Adjustment (MCA) program.
- Drive timely delivery of claim mass adjustment & recycle initiatives.
- Identify areas of concern (ongoing issues, trends, etc.) that can serve as impediments to successful processing.
- Serve as escalation point for Claims, PNM, Contract Configuration and Provider File Operations and remove barriers to high quality and/or timely delivery of mass adjustment/recycle requests.
- Ensure business areas (Claims, PNM, Contract Configuration, Provider File Operations, etc.) are providing timely review, feedback and approval on mass adjustment & recycle initiatives.
- Identify opportunities and needs pertaining to system enhancements, improvements and fixes for better quality and efficiency of the Mass Claims Adjustment (MCA) program.
- Collaborate with IT to ensure necessary system changes are completed as per requirement and in a timely manner.
- Bachelor s Degree required; additional experience/specialized training may be considered in lieu of educational requirement
- 3 5 years of relevant professional work experience required
- Experience in health insurance claims required
- Vendor oversight management experience required
- Staff and/or process supervisory/managerial experience required
- Excellent communication skills (verbal, written and interpersonal) required
- Ability to work independently or in a team setting required
- Strong analytical and problem-solving skills required
- Proficient with MS Office (Word, Excel, Powerpoint, Outlook) required
- Requisition ID: 22097
- Hiring Range: $70,000-$80,000
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