This San Francisco Bay Area Health Plan is actively interviewing for a Claims Analyst to join the Operations and Finance team. Join a dynamic and resourceful organization that is making significant impacts on the lives of so many SF citizens.
The Health Plan Claim Analyst will join an amazing team of clinical and administrative personnel in an integrated health system that has served the San Francisco community for over 50 years. This non-profit health plan is always working to expand coverage and benefits to deliver the highest quality care at the lowest price, getting the most for its customers. The Claims Analyst will join an organization that offers products and plans for Small (2-50), Medium (51-200), and Enterprise (1000+) Groups, as well as Individual and Family Plans both on and off the exchange.
Reporting to the Health Plan Claims Operations Manager, the Analyst will directly support both financial goals and membership growth targets. This person will play an integral role Claims Department Operations, customer support, and performance improvement.
Working with a strong Claims, Grievances, and Appeals management team, the Health Plan Analyst will have the opportunity to partner across organizational boundaries to lead, coordinate, support, and represent the claims team with Health Plan Audits conducted by a variety of regulatory agencies (including CMS, DMHC, and TPA Partners). This person will work on the front line of department operations to:
- Support administrative duties in the department such as policy and procedure development, workflow improvement projects, and process flow analysis to improve performance.
- Serve as a leader in the department, assigning work and priorities to the claims team in coordination with the Claims Manager / Supervisor, regulatory, and contractual obligations.
- Monitor and accurately report claims and claims results, identifying issues and escalating when required to keep all stakeholders aligned.
- Develop and deliver reports that measure and communicate results of Health Plan initiatives, generate reports for regulatory partners, and conduct internal audit reporting.
The San Francisco Bay Area is well known to have something for everyone. If you can appreciate great art, a delicious meal, or the great outdoors, you’ll find something special here. Contemporary street art, murals, galleries, and public installations adorn the streets just about everywhere you look. Hundreds of acres of coastline, nature trails, and parkland surround one of California’s most beautiful cities. With Silicon Valley and San Jose a short distance to the south, Stanford, UC Berkeley, and some of California’s best primary schools, the Bay Area is a great place for the Health Plan Claims Analyst. Connected by Bay Area Rapid Transit and one of the nation’s best networks of buses and light-rails, you’ll find that it’s easy to get where ever you’re going.
You’ll play a vital role in the development and activities of this health organization. Supported by a strong leadership team, a stable organization, and a thankful community, the Health Plan Claims Analyst will find a great place to be. This person will also find a competitive salary and generous benefits package await you.