Quality Assurance Business Analyst (Carmel, IN)

at  BeneSys Inc

SUMMARY

We are looking for a motivated self-starter to join our team as a Quality Assurance Business Analyst. You’ll be working with our Plan Build team to review Summary Plan Definitions (SPDs) and other documentation and then configure those Plan Benefits in our SpyGlass claims module. It would be helpful to have background knowledge in health insurance and/or Software as a Service, although this is not a requirement.
The best candidate will be a team player who is enthusiastic and loves to learn!

BUSINESS ANALYST REQUIREMENTS

• Bachelor’s degree or higher preferred
• Experience working in medical claims processing, medical coding, or software configuration
• Enthusiasm for learning new things and a willingness to become a subject matter expert in Spyglass
• Excellent communication skills (written and verbal)
• Ability to calculate accumulators involved in claims processing, such as different out of pocket and coordination of benefit methodologies

BUSINESS ANALYST RESPONSIBILITIES

• Interpretation of Summary Plan Descriptions
• Set up the benefits for Medical, Vision, Dental, Flex, and Short-Term Disability Plans.
• Set up and maintain the logic that drives the claims to the Benefit codes, by using the fields that are on a HCFA or UB-04
• Maintain the Category Definitions used in logic
• Identify methods to improve auto-adjudication
• Create the benefit outlines for new or converting Funds
• Make revisions to the benefit outlines when a Fund has a plan or system change
• Document and track Plan change requests in the IT ticket system
• Assist with standard and custom reports as it relates to the claims
• Testing of new system releases and the interim patches
• Troubleshooting of claims processing and system issues
• Review accuracy of converted claims history and accumulators when new Funds are implemented
• Document procedures
• Provides analysis, definition, and direction to computer applications related development and maintenance activities
• Ensures correct business functionality, requirements, and industry standards are addressed within the software application
• Regular and predictable attendance is an essential function of this job
  Physical Requirements - Extended periods of sitting/standing. Extensive keyboarding.
  Work Schedule - Full time. Monday – Friday, 8:30am - 5:30pm.
  Flexible/hybrid schedules available with the potential to work from home occasionally after demonstrated performance.