Analytics
Analyst, Payment Integrity
Pune, Maharashtra, India

         

Job title

Analyst, Payment Integrity

Department

Claims Discovery

Report To

Phillip Evans

No of yrs. of exp

1-3

Work Location

Pune/Remote

No of Positions

1

Assigned Recruiter

 

Talent Partner

 

 

Version Control

Version No.

Date

Remark

Updated by

1.0

04/07/2020

Draft

Kevin O’Donnell

 

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

 

Position summary

As a critical team member of the Payment Integrity team partnering with Health Plan Services (HPS) this role helps to support the analytics and reporting for Payment Integrity Services. The Analyst for Payment Integrity is responsible to support the needs and direction of the Claims Discovery Leader and priority initiatives for payment integrity related to existing HPS clients. Given the nature of the role, (s)he is expected to employ a consultative and analytical approach to issue resolution.

This role is an ideal fit for someone who enjoys working in a fast-paced, hands-on, client-facing environment with a heavy focus on cross functional operations and process improvement. This individual also helps track performance against SLA’s and other key performance indicators.

This is role is meant to be a foundational starting point to develop and launch outstanding talent and future leadership into the HPS organization. Reporting to the Associate Director, Payment Integrity and has multiple career path options to grow into.     
 
Essential functions

 

  • Support the Payment Integrity Team reporting needs, e.g.:
    • Retraction files (promoting uniformity for data load)
    • Monthly membership file
  • Assist with developing and maintaining:
    • Financial reports
    • Executive status reports
    • Standard stack of Payment Integrity related reports
  • Build Payment Integrity data warehouse tables that support multiple clients and functions
  • Generate ad hoc data analysis as needed
  • Develop and standardize the identification of in-house audit Concepts
  • Build user guides for newly created analytic processes
  • Support business goals & system fixes by claim reviews, analyzing, identifying, and resolving issues
  • Participate in documenting and prioritizing potential solutions to issues & fallout for system issues
  • Establish and implement interim workaround solutions as needed and communicate to all impacted users
  • Effectively handle multiple initiatives as the same time
  • Other duties as assigned


Academic Qualification

  • Associate or Bachelor degree preferred.
  • Experience in health insurance claims processing
  • HMO Claims or managed care environment preferred.

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