Operations Analyst

Employer Industry: Healthcare Services

• Opportunity for career advancement and growth within the organization
• 10% annual incentive target based on company, department, and individual performance goals
• Comprehensive benefits package including medical, dental, vision, and 401(k) with employer match
• Paid Time Off (PTO) starting at 17 days per year, plus 10 standard holidays and 2 floating holidays
• Monthly stipend to offset work-from-home expenses for fully remote roles
• Commitment to reducing health disparities and creating an equitable work environment

• Interpret and apply state and CMS claims benefits, overseeing system benefit and pricing configuration
• Gather business requirements for claims benefit configuration to support system updates and new product implementations
• Facilitate the development and execution of user acceptance testing for system changes and enhancements
• Provide support for electronic data interchange (EDI) and web-based interfaces
• Ensure compliance with state, CMS, and OIC requirements, including pricing and audit performance

• Bachelor's degree in healthcare or related field, or equivalent combination of education and experience
• Minimum three (3) years of managed care/health plan operations experience
• Minimum two (2) years of business/operations analysis experience in a related field
• Knowledge of claims adjudication, benefits configuration, and electronic data interface
• Ability to gather and assess data, problem-solve, and consult with stakeholders

• Background in Medicaid and Medicare claims adjudication, benefits configuration, and claims coding
• Experience with quality improvement methods and tools
• Strong project management and team facilitation skills
• Excellent verbal and written communication skills
• Technical, analytical, and process documentation skills

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position.

Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.