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Company :

Highmark Inc.

Job Description :

JOB SUMMARY

HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.

This job performs highly complex benefit coding, new client and group installation, as well as set-up of network structures (e.g. non standard tiering) and pricing methods in a senior operational role. Translates complex group and client information into system configuration, including but not limited to client, group, rates, and commissions data resulting in the design and maintenance of complex groups and products. Applies knowledge of the sequencing of benefit categories and benefit provisions information to provide expert data analysis regarding complex data processes and business rules.

ESSENTIAL RESPONSIBILITIES

+ Perform highly complex benefit coding, new client and group installation, as well as set-up of network structures (e.g. non-standard tiering) and pricing methods.

+ Analyze and verify client, group, rate, commissions, product and benefit data, and allocate to appropriate (available, qualified) resource.

+ Design and apply coding and configuration principles to ensure proper coding outcomes and scalability and reusability of benefit configurations. Develop and execute claims testing plan, scenarios, documentation and defect management to ensure minimal production defects are realized. Complete analysis of the results tying back to customer impacts. Interface closely with the business and technical staff during all phases of a project, including unit and system testing, integration and UAT testing culminating with implementation checkout and post implementation support.

+ Work independently, or as part of a team, to develop benefits solutions to enable customer requirements for projects, mandates, and changing business needs for new or existing benefit designs.

+ Provide required business and/or subject matter expertise for both project and production related activities. May also participate as a subject matter expert in strategy development for new strategic programs.

+ Research and analyze claims processing problems, perform initial problem identification and resolution activities, and debug benefits and medical policy program coding. Document the results of problem analysis/research and prepare the specifications necessary to identify impacts to claims processing or other business logic.

+ May provide assistance on development of project deliverables – e.g. vision documents, business requirements, use cases, supplemental specifications, user design, testing plan, testing schedule, testing scenarios, testing outcomes, approvals, and training materials.

+ Other duties as assigned or requested.

EDUCATION

Required

+ High School Diploma/GED

Substitutions

+ None

Preferred

+ Associate’s Degree in Healthcare Administration, Business, Information Science or other related field

EXPERIENCE

Required

+ 5 - 7 years of experience in health care industry or other related field

+ 5 - 7 years of experience in business analysis, system analysis, or other related function working with logical data structures

Preferred

+ 5 - 7 years of experience in health insurance operations, benefits operations, or other related field related is preferred

+ 5 - 7 years of experience with client, product, and/or benefits configuration techniques

LICENSES AND CERTIFICATIONS

Required

+ None

Preferred

+ None

SKILLS

+ Excellent detail-oriented skills

+ Advanced customer service skills with moderate experience working with customers, sales, and/or clients

+ Excellent oral and written communication skills

+ Advanced proficiency in understanding, analyzing, and applying highly complex business rules and configuration concepts

LANGUAGE REQUIREMENT (Other than English)?

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches/Trains others regularly

Rarely

Travels regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (Sales employees)

Does Not Apply

Physical Work Site Required

No

Lifting: up to 10 pounds

Does Not Apply

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._

**_Compliance Requirement:_** _This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$50,200.00

Pay Range Maximum:

$91,200.00

_Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J262240