Claims Business Technology Analyst II

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🔥 17 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $87.3k - $119.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

🚘 Automotive

🏥 Healthcare

⚖️ Legal

Automotive • Healthcare • Legal

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 Description

• Provides business technical support to operations across the Service Division to ensure successful implementation of automation and efficiency projects/programs to ensure the achievement of claims timeliness and quality goals • Works with Service departments to coordinate prioritization of projects and works with IT and Claims System vendors (NASCO) for implementation and maintenance • May conduct User Acceptance Testing (UAT) for Service Division projects, implementations, system fixes and enhancements • Collaborates with the business groups to develop, document and standardize reporting procedures and workflows to support operational improvement • Manages Claims Stop governance and maintenance to minimize claims stops and assure discipline, documentation and audit trail • Leverages existing technology by identifying opportunities to automate manual processes and interventions; identify opportunities to incorporate and standardize new technology into processes and flows • Creates opportunities by working with IT on new solutions and business on EDI gateway claim editing possibilities • Works with IT and corporate departments to help monitor service level agreements on Plog timeliness; recommends alternate approaches for handling for effectively • Work across Service departments to achieve business goals; leverage key internal and external relationships to access the information, products and resources (technology, training, staff, etc.) necessary to successfully support Claims and related Service goals • Reviews BRDs and offers commentary as required • Provides Subject Matter expertise to Service teams as needed on business technical issues and audit activities • Prepare materials for internal and external audit activities, review audit findings/reports for accuracy and completeness • If appropriate, formulate rebuttal and/or corrective actions steps • Provides post-implementation check out of system enhancements and thorough overview of enhancements to business owners

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires broad-based Operations or IT experience with a minimum of 5 years in managed healthcare or related industry • In lieu of Bachelors degree, an additional 3 years of experience in Operations or IT is required • Successful track record in managing operations with process improvement background desired • Past experience on system implementations in a fast-paced, high pressure environment is preferred • Claims systems knowledge is required • Project management experience is a plus • Experience with specialty health plan products/groups helpful • Prior background in managing change and developing new operations is preferred • Requires broad understanding of claims systems and related ancillary systems used in the Service Division • Requires business and/or technical expertise from previous claims projects and work flow changes and impacts • Requires knowledge of the deep understanding of the NASCO or FACETS system • Requires knowledge of project management life cycles and related tools and practices • Must have a solid understanding of claim processing including pricing and code editing • Must have strong organizational and analytical skills and demonstrated ability to effectively manage multiple projects at one time • Must have strong inter-personal skills with a demonstrated ability to lead cross-divisional work teams • Must demonstrate an understanding of the interdependences between the business, clinical and financial side of the health care business • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint, MS Project) and Lotus Notes • Should be knowledgeable in the use of intranet and internet applications • Must have a working knowledge of the impacts of mandates and legislation on overall claims processing and contracting

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement