Benefit Support Analyst III - Remote Eligible

Benefit Support Analyst III

The Benefit Support Analyst III is responsible for reviewing and breaking down complex medical business requirements into configurable requirements and working with configuration and other partners in helping to develop the strategic direction of member benefits across all states and product lines.

Essential Functions

Create and maintain benefit grids with annual and ad hoc changes

Create, maintain, review, and analyze configuration templates to validate benefit requirements and regulations are accurate; collaborate with policy and markets to confirm and resolve conflicts

Perform peer review of configuration templates and provide documentation of results within the defined SLA guidelines; identify and implement opportunities for process improvement

Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvement, and identify root cause resolution of issues

Participate in the annual benefit change process with Product Management and Benefit Analysts as appropriate per market

Create and utilize reports to analyze data to assist with issue resolution and impact analysis

Adhere to defined SLAs while also accommodating urgent requests

Incorporate critical thinking skills, discretion, and independent judgement into the analysis process to determine the best course of action for each issue/task

Create and maintain SOPs and supporting process flows

Provide guidance and mentorship to teammates/peers

Update and maintain the data management tool

Lead and facilitate cross functional or project meetings as assigned

Assist in the training and development of new hires and continuous training for peers

Manage the Quarterly Code Process across multiple teams for all LOB's

Lead and/or participate in projects as assigned

Act as Back up to Team Lead, Triage Analyst and all BA functions as needed

Perform any other job-related instructions as requested

Education and Experience

Bachelor's degree in a related field or equivalent years of relevant work experience is required

Minimum of five (5) years of medical benefit plan design and/or configuration experience is required

Configuration experience (Facets or equivalent system) preferred

Managed Care or healthcare experience is preferred

Competencies, Knowledge and Skills

Advanced computer skills with Microsoft Suite

Proven understanding of database relationships preferred

Advanced knowledge of CPT, HCPCs and ICD-CM Codes preferred

Working knowledge of other claims related reference data, such as types of bill, revenue codes, places of service

Proven understanding of the upstream and downstream impacts of code level benefit details

Problem solving skills

Communication skills, both written and verbal

Ability to work independently and within a team environment

Attention to detail

Knowledge of Medicare, Medicaid or Marketplace medical insurance benefits preferred

Claims processing knowledge preferred

Ability to work in a fast-paced environment managing multiple priorities

Ability to build and maintain strong working relationships with cross-functional teams

Knowledge of regulatory requirements of Outpatient Prospective Payment System (OPPS) and other payer requirements preferred

Ability to break down complex benefit requirements

Excellent organizational skills and ability to meet deadlines

Strong interpersonal skills and high level of professionalism

Facets or other systems knowledge/training preferred

Decision making/problem solving skills

Working Conditions

General office environment; may be required to sit or stand for extended periods of time

Occasional travel (up to 10%) to attend meetings, training, and conferences may be required

Compensation Range

$70,800.00 - $113,200.00

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary): Salary

Organization Level Competencies

Create an Inclusive Environment

Cultivate Partnerships

Develop Self and Others

Drive Execution

Influence Others

Pursue Personal Excellence

Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.