Claims Quality Analyst

Claims Quality Analyst
Who are we?
Versant Health is one of the nation’s leading administrators of managed vision care, serving millions of our clients’ members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.
As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.
See how youcan make a difference with the support of strong leadership and a team environment. See Everything, Be Anything™.
What are we looking for?
The Claims Quality Analyst is responsible for conducting quality reviews of work performed in the Billing, Enrollment, and Claims Departments in accordance with Departments guidelines. The incumbent will analyze findings, report results and make suggestions on process improvements where common errors have been identified. In addition, the Claims Quality Analyst will engage in department and/or corporate projects, as necessary and assigned, to continually ensure that the work performed in these functional areas is accurate and complete.
Where you will have an impact

• Responsible for conducting a quality review of functions performed in Client Billing, Enrollment, and Claims.
• Recommend corrections/changes to the systems, policies, and procedures, as needed, to ensure the highest quality of work performed.
• Assist the department Manager with conducting a routine review of the quality program to ensure it constantly meets business and regulatory requirements.
• Provide regular feedback and recommendations to department Manager regarding staff performance.
• Assist in department/corporate projects, as assigned by department Manager/Director, to ensure that system upgrades, changes in policies, procedures or benefits are introduced into the department accurately and timely.
• Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within departmental goals. This is in addition to the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements.
• Adhere to privacy, confidential and proprietary company policies and procedures (i.e. HIPAA).
• Perform additional duties as assigned by department Manager to support quality functions within the Billing, Enrollment, and Claims Departments.

What’s necessary to do the job?

• Preferred Bachelor's degree in related field or equivalent combination of experience and education
• Minimum One (1) year of related experience

HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.
Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
The wage range for applicants for this position is [$50,000.00 to $55,000.00].
All incentives and benefits are subject to the applicable plan terms.

Health insurance, Dental insurance, Tuition reimbursement, Vision insurance, 401(k) matching, Opportunities for advancement, Pet insurance