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Medical Claims Contract/Benefit Configuration Specialist- MediGold Healthcare plan -Remote
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Job Description
- Req#: 00631327
Employer Industry: Medicare Advantage Insurance
Why consider this job opportunity:
- Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one
- Retirement savings account with employer match starting on day one
- Generous paid time off programs
- Tuition/professional development reimbursement starting on day one
- DailyPay available for eligible employees, allowing access to earned wages before payday
- Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups
What to Expect (Job Responsibilities):
- Serve as a primary expert within the Health Plan for configuration and maintenance of contracts, fee schedules, and benefits
- Assist in developing provider contracts, fee schedules, and benefits to ensure efficient implementation and administration
- Test and document all configuration changes to ensure no adverse impact on other areas
- Develop and perform audits as needed to ensure effective administration of contracts, fee schedules, and benefits
- Maintain an in-depth working knowledge of all facets of the adjudication platform
What is Required (Qualifications):
- Education: Associate or Bachelor's degree preferred
- Minimum of 5 years of experience in medical claims or relevant health insurance
- In-depth understanding of Medicare and Medicare Advantage
- Excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform accurately, timely, and simultaneously
- Ability to help develop, interpret, and implement provider contracts, fee schedules, and member benefits
How to Stand Out (Preferred Qualifications):
- Experience working with ad hoc reporting and analysis for configuration or process improvement
- Familiarity with claims processing systems and DLTs for claims processing staff
#MedicareAdvantage #HealthInsurance #CareerOpportunity #CompetitivePay #ProfessionalDevelopment
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