d.light ยท 5 months ago
Claims Compliance Analyst
East Longmeadow, MA
Full-time
Onsite
Mid, Senior Level
5+ years expd.light is a company seeking a Claims Compliance Analyst to join their team in a fully remote position. The role involves maintaining knowledge of claim processes, processing claims, and ensuring compliance with internal policies and regulations while collaborating with various departments.
Renewables & Environment
Responsibilities
Navigate different claims systems
Work within systems like RegEd to review assigned tasks and implement new laws, rules, and regulations
Work cross-departmentally to understand and implement new and/or existing regulations utilizing systems such as RegEd
Maintain an in-depth understanding of the claim adjudication process
Process claims by all regulations in a timely and accurate manner, including analyzing the submitted medical treatment and investigating the coverage terms
Maintain a strong understanding of state and federal health insurance regulations and mandates
Strong knowledge of products/systems, and a subject matter expert (SME)
Create, carry out, and audit compliance items linked to claims, including risk assessment, testing, and monitoring of important laws & regulations, rules & processes, help with exam preparation, issue reporting & escalation, training materials, and remedial measures
Assist in market conduct exams by reviewing claim-related tasks
Create and implement procedures for regulatory items impacting claims that require special handling
Regularly partake in compliance-related meetings
Review all claim-related compliance reports to ensure accuracy
Scrub pay-related reports to accurately determine the clean claim date and proper penalties/interest
Handle claim adjustments related to regulatory requirements
Perform other duties as assigned
Qualification
Required
A minimum of 5 years of experience in health insurance claim processing is required
Capacity to plan, carry out, and document compliance self-monitoring initiatives
Ability to comprehend complex laws/regulations
Ability to assess, prioritize, and communicate claims risk
Ability to understand complex problems, identify root causes, and remain goal-oriented
Strong analytical skills, with the ability to effectively identify, communicate, and address potential issues
Strong written/verbal communication, interpersonal, and presentation skills
Ability to work in a fast-paced environment, prioritize multiple assignments simultaneously, think quickly, meet deadlines, and adapt to various situations
Ability to work independently, with peers, and with departments in business areas at all levels of the organization
Benefits
Fantastic benefits
Company
d.light
d.light is a global leader and pioneer in delivering affordable solar-powered solutions designed for the two billion people in the developing world without access to reliable energy.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Karl Skare
Chief Product & Strategy Officer
Company data provided by crunchbase