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Independence Blue Cross · 4 months ago

MCT Workstream Analyst (Payment Integrity) - Hybrid (PA/NJ/DE)

Philadelphia, Pennsylvania

Full-time

Hybrid

Mid, Senior Level

5+ years exp

Independence Blue Cross is focused on renewing and reimagining healthcare, seeking committed individuals to join their team. The MCT Workstream Analyst supports managers in achieving medical cost savings by conducting research and analyzing claims processing rules to identify cost transformation opportunities.

Health CareHealth InsuranceInsuranceMedical

Responsibilities

Assist in resolution of internal and external requests related to the payment optimization workstream coming from diverse areas (including but not limited to via Service Now incidents)

Assist with monitoring claim editor release notes and updating the Health Rules platform for new or modified edits

Provides regular status reports on all outstanding incidents, tickets and tasks

Identify, track, and report specific trends and issues related to inquiries and getting claims reprocessed across all platforms

Monitor inquiries, tickets and issues, with follow-up regularly with all internal and external partners across multiple related departments

Review and monitor payment optimization vendor reporting, recognizing changes in trends, aged claims with appropriate escalation when needed

Research and root cause internal and external claim questions that may arise from payment optimization workstream vendors and other related MCT initiatives

Maintain vendor task tracker(s) across platforms, ensuring viability for all stakeholders

Other management assigned payment optimization related tasks, as needed

Qualification

Advanced EXCELClaims researchAnalysisManaged care experienceProblem-solving skillsResearchProduction inventory managementHealthEdge experienceTeam collaboration