Membership Operations Analyst (Healthcare)

Strategic Staffing Solutions; Detroit (MI); On-site; USD 50,000 - 70,000; Full time

Job summary

A staffing solutions company in Detroit is seeking a candidate for a role focused on analyzing and processing membership transactions. The ideal candidate should have a Bachelor’s Degree and possess strong analytical and communication skills, along with two to five years of experience in a related field. Proficiency in Microsoft Office is crucial for this position, which also requires the ability to work independently and contribute to process improvements. Candidates with experience in healthcare enrollment will be preferred.

Qualifications

• Two to five years of experience in a related field is required.
• Ability to lead and contribute to process improvement programs.
• Demonstrated flexibility and ability to work independently.

Responsibilities

• Analyze, process and expedite operational membership transactions.
• Participate in systems testing and develop procedures.
• Provide leadership team with status of issues.

Skills

Membership inquiry or claims processing experience

Analytical skills

Effective verbal and written communication skills

Interpersonal skills

Organizational skills

Problem-solving skills

Education

Bachelor’s Degree in related field

Tools

Microsoft Outlook

Microsoft Excel

Microsoft Access

Microsoft Teams

Job description

Overview

Primary responsibility includes working closely with external customers who submit 834 membership files. Knowledge of the 834 HIPAA compliant file layout is highly desirable. Apply, analyze, and manage 834 and membership business rules. Manage email and phone inquiries from external customers related to 834 customer inquiries.

Responsibilities

Analyze, process and/or expedite operational membership transactions; this may include timely resolution of problems. Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process. Provide leadership team with status of issues. Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, letters, and communications. Assist personnel (both internal and external) by answering questions and supplying information. Develop and maintain an effective working relationship with customers or partners. Other duties may be assigned.

Qualifications

• Bachelor’s Degree in related field preferred.
• Demonstrated knowledge/competency in the following areas: membership inquiry or claims processing experience preferred, analytical experience, ability to produce statistical information from conceptual needs, and working with PC application and/or mainframe systems preferred.
• Effective verbal and written communication skills.
• Ability to lead and contribute to process improvement programs.· Excellent interpersonal skills necessary to interact with all levels of all personnel.· Other related skills and/or abilities may be required to perform this job.

Required Experience

• Two (2) to five (5) years’ experience in related field is required.
• High proficiency with Microsoft Suite primarily Outlook, Excel, Access, and Teams.
• Demonstrated skills including organizational (ability to prioritize multiple assignments), analytical (attention to detail), and interpersonal (written and oral, including internal and external contacts) are required.
• Ability to perform as a self-starter, with motivation to consistently produce high quality results is required.
• Strong creative problem-solving skills.
• Demonstrated flexibility, self-discipline, and ability to work independently, as well as within a group is required.
• Ability to make decisions within scope of responsibility where operational guidelines/procedures are non-existent.
• Other related skills and/or abilities may be required to perform this job.

Preferred Experience

• At least two (2) years of healthcare enrollment, membership/billing experience preferred.
• Working knowledge of BCN operating systems/applications considered a plus (Facets, EOS, Macess).
• Knowledge of the 834 HIPAA compliant file layout is highly desirable.