Medicare Supplemental Benefits Analyst

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

Description

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Medicare Supplemental Benefits Analyst to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview

The Medicare Supplemental Benefits Analyst will be responsible for evaluating, interpreting, and administering Medicare policies, Supplemental claims data, and regulatory compliance in relation to administration of Supplemental Benefits. The role reviews coverage eligibility, manage beneficiary monthly/quarterly/annual limits, and analyzes cost and utilization data. The Analyst serves as the subject matter expert for all Supplemental Benefits administered by Verda Healthcare, Inc, including Dental, Vision, Acupuncture/Chiropractic/Massage Therapy, Hearing Aid, OTC items, Transportation, and other benefits. The Analyst is also responsible for investigating and reconciling vendor invoices by validating them against Member Eligibility and Supplemental claims data to ensure accurate payment, as well as deep-dive analysis to prevent fraudulent or predatory behaviors by contracted Supplemental vendors and active Verda membership.

This position reports to the Business Systems Manager.

Responsibilities

• Review documents (e.g., protocols, agreements, budgets, etc.) to determine coverage expectations and assess billing implications
• Validate invoices for eligibility and monthly/quarterly/annual limits
• Work with Finance team to troubleshoot and resolve billing issues
• Serve as a subject matter expert for colleagues involved in Supplemental Benefits discussions, offering insights on utilization, billing, and coverage analysis
• Provide Leadership and cross-functional teams with follow-up information and clarification on coverage analysis outcomes
• Collaborate with Leadership, Compliance, and Legal Counsel to ensure alignment with regulatory and institutional standards
• Communicate with external vendors as needed
• Contribute to the development of educational tools and resources for Verda staff
• May participate in bid process meetings for upcoming years, updating coverage analyses as market analysis and other relevant information evolves
• Cost containment through investigations of vendor and member spending and utilization, including identification of potentially fraudulent or predatory actions

Professional Competencies

• Collaborative approach when working with vendors and internal team members
• Strong analytical and problem-solving skills
• Effective verbal and written communication skills
• Strong understanding of Medicare Supplemental Benefits, limitations, and impact of potential solutions
• Ability to work independently on moderately complex work assignments, monitor progress, and evaluate results with minimal supervision

Verda Healthcare cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time

Location: Huntington Beach, CA

Compensation Range: $71,000-$80,000

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance

Schedule

• Full-time onsite (100% in-office)
• Hours of operations: 9am - 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.

Requirements

• Bachelor's Degree in business, computer science, information technology, or equivalent business experience
• Prior experience at a health plan or MSO
• Knowledge Base:
• Strong familiarity with Medicare Advantage, Part D, CMS compliance, and risk adjustment models
• Understanding of CMS regulations and Medicare Advantage plan operations
• Experience working with healthcare eligibility and provider data
• Technical Skills:
• Proficiency in advanced Excel, SQL, or healthcare database management systems
• Proficiency in other Microsoft Office Suite products (Word, OneDrive, OneNote, etc.)