Business Systems Specialist – HPS

Summary

Summary 

Responsible for the configuration and maintenance of health plan groups, plans, and eligibility. Also responsible optimizing business rules, benefits, and service categories in our claims processing software to accurately adjudicate claims according to a plan’s liability limits and member utilizations. Analyzes complex data and presents results in an understandable format using tools such as MS Excel and/or MS Access. Serves as a business analyst and consultant to management and others needing insights to information by understanding their key business needs/opportunities and utilizing expertise with Health Plan information to recognize opportunities.

Education 

Bachelor’s degree in a Quantitative Analysis, Heath Care, Information Systems or related field.

Experience

REQUIRED: Three years of experience presenting and analyzing information and data structures. Proven experience interpreting data to influence decisions. Proven experience collaborating in a team environment to deliver solutions.

PREFERRED: Experience in a health care, insurance, or data analyst role. Previous experience with healthcare claims information. Experience using Qlik, Tableau, or other Analytics tools. Some experience with SQL queries. Experience with MS Excel using complex formulas, vlookup, data import/export using delimiters, csv, or flat files.

Other Qualifications

TECHNICAL REQUIRED: Proven track record working with complex data. Strong computer skills in a Windows environment. Strong MS Excel skills. Aptitude with charts that present trends and comparisons is essential.

BUSINESS REQUIRED: Ability to understand and analyze healthcare claims and healthcare plans information.  Ability to manage accuracy and timeliness of deliverables. Effective documentation skills. Exceptional verbal and written communications skills.

PREFERRED: Knowledge of health plan benefit plans and related setup.