Facets Benefits Analyst

Des Moines, IA

Posted: 10/02/2019 Job Category: Information Technology (IT) Job Number: 3082

FACETS BENEFITS ANALYST, DES MOINES, IA

WalkerHealthcareIT is seeking a Facets Benefits Analyst  for a healthcare client located in Des Moines, IA. This is a contract position.

START DATE: ASAP

ON-SITE / REMOTE: On-site

DURATION: Ongoing

WalkerHealthcareIT Standard Perks
  • Weekly pay via Direct Deposit
  • All expenses paid including Per Diem
  • Weekly expense reimbursement via direct deposit (within 5 days)

FACETS BENEFIT ANALYST JOB SUMMARY

Provide high quality and timely benefit system logic for complex and performance group contracts in accordance with regulations and guidelines. Provide sales, product and marketing with benefit design solutions and update benefit system maintenance tables/ configurations. As needed, coordinate projects and contribute to cross functional workgroups specific to benefit file enhancements, system changes, and implementation teams. Analyze and interpret other carrier’ s summary plan description and ensure benefits are accurately transferred to Health Plan’ s format. Identify potential issues and provide alternatives when benefit designs cannot be accommodated.

FACETS BENEFIT ANALYST JOB RESPONSIBILITIES
  • Develop and implement benefit logic for use in automated claims adjudication, representing all business rules, processes, and regulations that apply to plan designs sold to our customers.
  • Analyze complex and highly customized benefit designs and determine how they impact system logic for claims adjudication processes. Determine when systems need to be updated and/or created by leveraging warehouse claims data and other internal resources.
  • Ensure that documentation is complete and accurate to support benefit decisions and to ensure compliance with State and Federal mandates.
  • Provide responses regarding benefit inquiries to Customer Service, Provider Service, Marketing, and other internal departments.
  • Work with testing specialists to develop test case schematics to verify accuracy of processing outcomes. Analyze and interpret outcomes to develop benefits logic that accurately supports the requested benefit design.
  • Work with members of sales and marketing to ensure customer product designs comply with Insurance Department regulations, Federal and State mandates, and Plan’ s policies and guidelines.
  • As needed, participate in projects as assigned. Perform research and make recommendations that consider all positive or adverse impacts to team processes and division objectives.
  • Analyze and interpret other carriers SPD’ s and ensure benefits are accurately transferred to Plan’ s OBS format. Identify potential issues and provide alternatives when other carrier’ s benefits designs cannot be accommodated.

FACETS BENEFIT ANALYST JOB REQUIREMENTS
  • Expertise in Healthcare Benefits. Able to understand and articulate benefits in healthcare language
  • Experience in FACETS is preferred

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