Claims Controller

Job Description:

The Business Analyst II reports to the Supervisor of the Central Business Unit (CBU) and performs moderate to complex tasks within our claims platform. This position may interface with system architects and corporate staff on benefit and contract updates, and system projects to support resolution of issues.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states:
California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington.

Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings

• This teammate will be working a M-F schedule, 8 hours a day, 40 hour work week. Full time position. Days off will consist of IHC holidays.

Provides expert-level skill in all areas of provider/vendor payment. Responsible for over $1 billion dollars per year in fee-for-service and capitation payments to our community of healthcare providers. Works closely with our payment vendor to ensure timely payments are made, resolve system issues, coordinate system upgrades, and deliver on new payment options as they become available. Partners with Intermountain Nevada Finance team to ensure funds are correctly withdrawn, all policies are followed, implement the escheatment process, and to resolve discrepancies.

Main point of contact for providers/vendors payment questions.

The Claims Payment Controller is responsible for ensuring the accurate and timely payment of all Intermountain Fee-for-Service and Capitation payments. The Claims Payment Controller accomplishes this by performing moderate to complex tasks within the claims and payment platforms. The position interfaces with system architects, business analysts, and corporate staff on all payment reconciliations, troubleshooting, and system projects to support resolution of issues.

• 5-8 years claims processing or system set-up experience, managed care preferred
• High School Diploma or GED required, some college preferred
• General knowledge of provider contracts, fee schedules and payment methodologies
• Knowledge of health plan benefit interpretation and set up
• Knowledge of current compliance legislation
• Strong interpersonal skills required
• Demonstrated proficiency in MS Excel and Word required
• Strong problem-solving skills required

• Responsible for quality and continuous improvement within the job scope.
• Responsible for all actions/responsibilities as described in company controlled documentation for this position.
• Contributes to and supports the corporation's quality initiatives by planning, communicating and encouraging team and individual contributions toward the corporation's quality improvement efforts.

Nevada Central Office

Las Vegas

Nevada