Reconciliation & Operations Analyst
Long Beach, CA
Internal Grade: N6
Our mission is simple: Keeping Seniors Healthy and Independentthat's been our mission for almost 40 years. Rated as one of the top Medicare Advantage plans in California, SCAN Health Plan employees are passionate about what they do. Understanding that success is based on achieving the mission, SCAN employees are afforded with the training and tools necessary to do their jobs and they are rewarded for their efforts and recognized as experts in their fields. Ask anyone who works here and we'll proudly tell you that SCAN's commitment has never wavered. We are as steadfast in our pledge to help our members live healthy and independent lives.
The Reconciliation & Operations Analyst will design and deploy activities within the Enrollment, Reconciliation, and Premium Billing Department that adhere to guidelines established by the Centers of Medicare and Medicaid Services (CMS), the Department of Health Care Services (DHCS), and other regulating agencies.
Support business units external, and internal, to the Enrollment, Reconciliation and Premium Billing Department with reconciliation and production processing efforts by completing regular and ad hoc projects involving reconciliation and business process designs and implementation.
Perform routine data analysis efforts to compare the plan's stored membership data to the data reported by regulating agencies and/or external departments.
Execute daily validations and error tracking for new member material mailings with the designated print vendor and coordinating resolutions to all findings with Operations team, management staff, and external vendors.
Review applicable organizational communications regarding changes to regulatory requirements and/or changes in data report file layouts and specifications from any/all regulatory agencies. Provide impact analysis for all related processes currently in place within the department and draft action plans to address and incorporate changes into the routine operations of the department.
Participates in, and/or leads, process design sessions to develop new processes, enhance, or remediate existing processes, in response to changes in regulatory requirements or data file specifications.
Conduct routine process analysis for the department's operating procedures and validate compliance with regulatory requirements, or develop detailed assessments outlining gaps/risks identified and proposed process redesigns to mitigate identified gaps and risks.
Develop and implement operating procedures to support the department's production and reconciliation processes by developing a series of queries to interpret and develop data results and developing standard operating procedure documents to outline the operating actions to be performed.
Participate in, routine audits internal to the Enrollment, Reconciliation and Premium Billing Department.
2+ years Eligibility and Reconciliation experience, preferably with a health plan or healthcare compnay
2+ years' experience with health services industry and managed care business
Strong interpersonal skills, including excellent written and verbal communication skills
Ability to multitask and ability to appropriately maintain confidentiality
Experience working with IKA platform
What's in it for you? Qualified employees will receive
A competitive compensation and benefits program
An annual employee bonus program
Generous paid-time-off (PTO)
Ten paid holidays per year
Excellent 403(b) Saving Plan, providing up to 4% match and vesting after three years
A work-life balance and much more!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!