You Make Us Grow. You Make Us Sharp.

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Start time can vary.

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$38.440 - $49.610 - $60.770

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
Working under the direction of the Manager of Benefits Administration, the Benefits Administration Analyst provides operational support to ensure benefit plans are designed appropriately and consistently and performance guarantees, service level agreements and operational goals are met. Ensures benefit information is clear, accurate, consistent, and delivered timely to internal and external partners. This individual will serve as a subject matter expert on benefits and provide support for translating plan designs and policies (i.e., Certificates of Coverage) into detailed business requirements, ensuring benefits are implemented accurately and timely, investigating and responding to internal and external benefit inquiries, and supporting claims testing activities.


Required Qualifications

• 3 Years in HMO or Health Insurance Management.
• Experience working collaboratively across multiple functional areas (e.g., operations, configuration, clinical, IT, plan design) and fostering teamwork.

Preferred Qualifications

• 2 Years experience in a health insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role.

Other Qualification Requirements

• Bachelor's degree in business, health services or related; or 4 years of relevant experience may substitute for degree. - Required

Essential Functions

• Leadership
  Display professionalism and teamwork in promoting the Mission, Goals and Objectives of Sharp Health Plan. Demonstrates content expertise regarding benefits administration and business operations and receives satisfactory customer feedback.
  Identifies client expectations and priorities through effective communication and interaction. Resolves conflicts with client expectations and department priorities under the guidance of the manager or designee.
  Proposes and implements creative solutions to problems. Participates in the interactions with clients to ensure understanding, agreement and attainment of project goals.
  Participates in training with other departments as requested.
• Benefit Development
  Translate plan design strategy and policies (i.e., Certificates of Coverage) into detailed requirements for benefit configuration. Develops and documents workflows, systems requirements, process analysis and testing (including reasonableness checks) provide efficient, cost-effective solutions as directed.
  Serve as the lead on claims testing and quality assurance activities and assisting in defect resolution.
  Assists in identifying impact of solutions on existing and future systems. May perform operational activities. Identifies reporting needs based on system programming and workflows and documents reporting requirements and testing of new reporting development prior to implementation to Production.
• Benefit Management
  Partner with Product Development, operational, clinical, and configuration teams to achieve benefit design solutions that align with plan design strategy and business requirements.
  Develop and document policies and relevant background information for other departments to better understand plan designs and benefit intent as directed.
  Assist with plans and benefits hand-offs to internal and external partners; develop and manage change control processes as directed.
  Provide subject matter expertise to address escalated benefit inquiries and complex benefit-related issues. Assist in Identifying opportunities to improve processes and build best practices for efficient and effective translation of product strategy/plan designs into configuration requirements leveraging new system capabilities or the integration of data/other applications into existing systems.
  Assist in creating and maintaining the necessary functionality in the benefit landscape, and workflows. Conducts root cause analysis, gathering data to pinpoint problem areas on which to focus. Recommends and implements solutions and evaluates results and implements controls to monitor consistent use of the solution as required.
• Communication
  Identifies key stakeholders who are internal and external. Includes various stakeholder roles, for example, process owner, approver, resource, team member, or interested party.
  Uses a variety of written and oral communication tools and techniques that are appropriate for the message and the audience. For each stakeholder, the goal is that they receive the communication they want, and that it is delivered when and how they want to receive it.
  Develops and achieves consensus on communication plans.
  Evaluates communication plans and refines processes for improvement.
  Works closely with management to provide education and otherwise facilitate the resolution of problems.
  Works with client leadership in obtaining input on projects and enhancements.
  Coordinates interactions with key vendors.
  Proactively communicates completion dates. Communicates in a timely fashion both to the requestor and management when project schedules may not be met.
  Ensures adequate communication of operational issues.
  Shares ideas and information with others who might find them useful
• Data Validation
  Performs the technical and administrative functions to assist the Benefit Administration team in benefit configuration validation projects to support benefit updates, major system enhancements, or release updates.
  Supports data validation activities when deploying changes to a large number of clients.
  Assists in design of data validation processes to ensure data checks fall within an acceptable range to ensure compliance standards are met. Activities should automate data validation, improve quality, and reduce costs.
• Internal and External Customer Service
  Interface with Health Plans, Providers, Members, Medical Groups and Internal Sharp Health Plan departments to resolve issues in a professional manner that maintains consistently positive relationships.
  Demonstrates a positive, professional and contributory posture in all matters requiring interface with customers, both internal and external.
• Audits
  Coordinates responses to both external and internal audits.
  Assists to ensure workflows support compliance and identify and recommend when audit protocols need to be refreshed to more accurately capture day-to-day procedures.
  Assist with evaluation of audit findings and works to implement new processes to bring Benefit Administration into compliance.

Knowledge, Skills, and Abilities

• Knowledge of health insurance or HMO operations with emphasis in the development or application of benefit interpretation guidelines, coverage policies, and/or reimbursement policies.
• Excellent working knowledge of medical terminology, CPT, HCPCS, RBRVS codes, and payor specific utilization and their modification and use.
• Federal and State regulations as related to benefit and claims adjudication.
• Adept at being an initiator of positive change to support the Mission, Values, and Goals of Sharp Health Plan.
• Ability to use data and analytical thinking to make fact-based decisions and/or recommendations.
• Solid problem-solving skills and ability to derive structure and clarity from ambiguous or open-ended inputs.
• Able to collaborate cross-functionally and enjoy deriving structure and clarity from ambiguous and complex inputs.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class