The Financial Analyst, Claims Adjustment role performs claims diagnosis to identify impacted claims that processed as a result of plan benefit updates. This diagnosis is a vital step in the Service Warranty process which begins with reviewing the parameters of an impact issue and then running data warehouse queries in order to identify the impacted claims. This activity touches millions of claims a year and is used to address benefit coding errors, eligibility changes, program features, and client requests.
A successful candidate will enjoy managing multiple projects in a fast-paced,process-driven environment. They will possess excellent communication and time-management skills.
Tasks associated with this position include:
· Extract claim and medical data from RxClaim or the data warehouse
· Perform ad hoc analysis
· Use CVS systems, Access, Excel and other tools to complete their tasks
· Summarize adjustment information into standard reports that reflect financial impact and details
· Communicate results and address questions about adjustment projects
Analysts work closely with Sales, Account Management, IT, Medicare Part D Services,Client Audit, Benefits, and Implementation teams to manage and coordinate the work.
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