Virginia Premier Health Plan Workforce Claims Analyst in Glen Allen, Virginia

About Us

Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.

By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.

At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.

If this sounds like you, read on!

Overview

This position is responsible for developing an extensive expertise in the overall functionality of the Virginia Premier Claim’s processes and payment systems. This position requires eye for detail, database knowledge and experience, ability to create data models, critical thinking and proven ability to be a problem solver. Ability to learn various software skills in order to support end-user operations is critical for this role.

Responsibilities

  • Monitor, organize the claims inventory, and ensure that the claims inventory is compliant with CMS and all other regulatory and governing bodies compliance guidelines;

  • Gather and review information related to staff performance and customer issues;

  • Determine ways to improve claims operations and workflow through effective staffing decisions so that departmental operational needs are met;

  • A major duty, will be to involves assessing staffing levels on a daily basis;

  • Workforce analysts may also create, develop and produce reports for the Claims department, as needed;

  • Analyze the same reports to determine if employees are being utilized effectively or/to develop strategies to recruit additional resources and/or qualified staff;

  • The workforce analyst will play a direct role in ensuring that company policies and processes are adhered to;

  • Produce Standard Weekly and Monthly Reports;

  • Assist in System Setup and Analysis;

  • Perform Analysis/Auditing on High-Dollar Claims and High-Volume Claims;

  • Assist in creation and analysis of Claims Operational trends;

  • Ensure all codes, fee tables, and updates are current and loaded correctly;

  • Support Claims System Manager on technical issues and/or projects;

  • Other duties as needed;

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s Degree in Business, Mathematics, or Information Systems

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Proficient knowledge of SQL queries to include ability to create and populate databases, perform data normalization, create query analysis, conduct table indexing, performing multiple table joins, and comfortable usage of functions (average, count, max, min, etc.)

  • Proficient knowledge of Microsoft Excel to include comfortably utilizing functions, developing charts and graphs, inserting formulas, performing VLOOKUP, and sorting and filtering data

  • Previous Computer Software and or Hardware experience;

  • Proven ability to analyze data;

  • Demonstrated experience in developing analysis queries;

  • Experience in use of information system resources;

  • Previous Claim Processing Experience a plus;

  • Leadership, communication and organizational skills;

  • Pays attention to detail with very strong analytical skills.

WORK BACKGROUND/EXPERIENCE

  • Minimum of one year experience with end-user or system support

  • At least one year in data analysis, programming or business analysis

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

Our mission is to inspire healthy living within the communities we serve!

Job ID 2018-5087

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.