Washington State Operations Analyst

Job Summary

A company is looking for an Operations Analyst responsible for process improvement and quality monitoring within Claims Operations.

Key Responsibilities

• Oversee claims benefit interpretation and system benefit configuration
• Gather business requirements for system updates and enhancements
• Ensure compliance with state and federal requirements related to claims and vendor management

Required Qualifications

• Bachelor's degree in healthcare or related field or equivalent experience
• Minimum three years of managed care/health plan operations experience
• Minimum two years of business/operations analysis experience
• Preferred background in Medicaid and Medicare claims adjudication
• Experience with electronic data interchange and encounter data reporting