Senior Analyst - MA System Liaison

About the role

Responsible for leading the development and implementation of programs and strategies by identifying insights that enhance business decision-making capability. This includes developing or changing workflows and implementing process improvements to enhance organizational products, programs, and service to customers.

• Identify and analyze operational data and develop insights in support of business objectives.
• Develop and improve workflows and business processes within defined areas to improve customer service, decrease operational costs, and improve overall quality.
• Identify and/or analyze business problems and develop recommendations for solutions.
• Lead the development and implementation of projects and/or teams to produce desired results.
• Document and communicate project concepts, milestones, and results.
• Recommend and assist with implementing standard policies and procedures.
• Ensure corporate compliance is communicated, implemented, and monitored on an ongoing basis.
• Participate in systems testing, develop procedures/controls, and provide recommendations for ongoing improvement of updated processes.
• Provide support to internal departments and external entities by answering questions, supplying information, and training.
• Create and present reports and presentations to display operational data and proposed business changes.

Department Responsibilities

• Design, develop, and implement new system claims logic for Medicare Advantage (MA) products.
• Configure MA benefit parameters within the claims processing platform, ensuring alignment with CMS guidelines.
• Perform detailed examinations of MA claims to verify accuracy, compliance, and proper reimbursement.
• Identify, document, and resolve defects in the claims processing system, collaborating with IT, NASCO, and vendor teams as needed.
• Stay current with CMS regulations, MA policy updates, and industry best practices related to claims processing.
• Analyze claim data to detect trends, root causes of errors, and opportunities for process improvement.
• Generate actionable recommendations and implement claim adjustment solutions to optimize payment accuracy.
• Produce regular reports and dashboards for stakeholders on claim performance, defect status, and resolution outcomes.

Requirements

• Bachelor’s Degree in a related field is preferred.
• Four (4) years of experience in a related field is required.
• Excellent analytical and problem-solving skills to identify, evaluate, recommend, and implement changes to processes or procedures.
• Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timelines.
• Excellent verbal, written communication, and interpersonal skills.
• Ability to lead and contribute to business unit and/or corporate projects.
• Proficient in Microsoft Office Suites.
• Ability to develop and maintain effective working relationships.