Medicare Benefits Analytics & Compliance Specialist

Verda Healthcare Inc; Huntington Beach (CA); On-site; USD 71,000 - 80,000; Full time

Benefits offered by this job

401(k)

Paid time off

Health insurance

Dental Insurance

Vision insurance

Life insurance

Job summary

Verda Healthcare, Inc. in Huntington Beach, CA seeks a Medicare Supplemental Benefits Analyst to evaluate, interpret, and administer Medicare policies, supplemental claims, and regulatory compliance for Dental, Vision, OTC items and other benefits.

You will review coverage, validate invoices, and work with Finance. The Analyst serves as SME for all Supplemental Benefits and collaborates with Leadership to ensure accurate payment and cost containment.

Qualifications

• Bachelor's Degree in business, computer science, information technology, or equivalent business experience.

Responsibilities

• Review documents to determine coverage expectations and billing implications.
• Validate invoices for eligibility and limits.
• Collaborate with Finance to troubleshoot billing issues.
• Serve as SME for Supplemental Benefits discussions and coverage analysis.
• Provide leadership and cross-functional teams with follow-up on coverage analysis outcomes.
• Ensure alignment with regulatory and institutional standards.
• Communicate with external vendors as needed.
• Develop educational tools for Verda staff.
• Participate in bid process meetings and update coverage analyses as needed.
• Investigate vendor and member spending to identify fraudulent actions.

Skills

Analytical thinking

Communication skills

Medicare knowledge

Independent work

Education

Bachelor's degree or equivalent

Tools

Excel

SQL

Microsoft Office

Job description

Verda Healthcare, Inc. in Huntington Beach, CA seeks a Medicare Supplemental Benefits Analyst to evaluate, interpret, and administer Medicare policies, supplemental claims, and regulatory compliance for Dental, Vision, OTC items and other benefits.

You will review coverage, validate invoices, and work with Finance. The Analyst serves as SME for all Supplemental Benefits and collaborates with Leadership to ensure accurate payment and cost containment.