Claims Analyst

Diversity Nexus; Mason (OH); On-site; USD 70,000 - 100,000; Full time

Job summary

Diversity Nexus in Mason, OH is seeking a seasoned Data Analyst to support the Business Configuration team by configuring managed vision care products in the Facets system, writing SQL queries, and providing data-driven insights to ensure accurate client configurations.

The role requires hands-on experience with Facets, strong analytical and communication skills, and the ability to manage multiple complex tasks independently or with a cross-functional team.

Qualifications

• 5+ years of experience in a core claims administration system.
• Good analytical and problem-solving skills.
• At least 2 years' experience writing SQL queries and exporting data for analysis.
• Good communication and interpersonal skills.
• Ability to work independently or as part of a team; manage multiple complex assignments.

Responsibilities

• Configure all types of managed vision care products in Facets using Product Key Sheet and manual methods.
• Ensure configuration accuracy using manual and automated product creation tools.
• Write SQL queries and export data to analyze and troubleshoot configuration issues.
• Handle configuration questions/issues with minimal guidance and resolve them.
• Maintain relationships with Implementation and Account Managers; work cross-functionally.
• Self-manage completion of work inventory in production queues within quality/service levels.
• Coordinate cross-functional activities for issue resolution and process improvements.
• Support management with training, projects, and configuration subject-matter expertise.

Skills

Analytical skills

Problem-solving

Communication

Teamwork

Independent work

Tools

SQL

Excel

Facets platform

Job description

FACETS experience is preferred but not mandatory

GENERAL FUNCTION

Serve as a Data Analyst on the Business Configuration team, responsible for the structure, and benefit plan set up for client's Managed Vision Care clients. Provide subject matter expertise for product configuration in the Facets system. Partner with client cross functional teams to ensure efficiency and accuracy of configuration requests.

MAJOR DUTIES AND RESPONSIBILITIES

• Responsible for configuring all types of managed vision care products in the system (using both the Product Key Sheet method and manual configuration)
• Responsible for product configuration accuracy utilizing the configuration tools for manual and automated product creation.
• Write SQL queries and export from database to analyze and troubleshoot configuration issues, as well as perform issue resolution of requests.
• Perform and resolve product configuration questions/issues sent to the Business Configuration production team without guidance.
• Maintain relationships with Implementation Managers, Account Managers, and develop a cohesive cross functional, results driven working environment.
• Self-manage completion of work inventory in the production queues within established quality and turnaround time service levels.
• Coordinate and participate in cross-functional team activities for issue resolution
• Recommend process and system enhancements to drive improvements.
• Support the management team with on-going training activities, misc. projects, resolving issues, and serving as a subject matter expert for all Configuration requests.

BASIC QUALIFICATIONS

• At least 5 years of experience working within a core claims administration system.
• Good analytical and problem-solving skills
• A minimum of 2 years' experience writing SQL queries and exporting data from database tables into Excel for analysis.
• Good communication and interpersonal skills
• Ability to work independently or as a part of a team.
• Ability to manage multiple complex assignments at once.

PREFERRED QUALIFICATIONS

• 3+ years' experience in Operations in the Healthcare industry
• Experience understanding claim adjudication for member and provider reimbursements.
• Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration
• Knowledge of Medicare and Medicaid programs