Healthfirst Operations Analyst - Claims Benefit Configuration in New York, New York


The Claims Operations Analyst is responsible for the tracking and reporting of data and preliminary analysis as it relates to activities which ensure operational effectiveness. Incumbents will assist management by preparing and verifying reports and interpreting trends. The Claims Operations Analyst owns the accuracy and timeliness of reported data as well as communication and resolution of identified issues involving reports and trends.

  • Write basic and complex data queries using SAS Enterprise Guide to generate required data sets.

  • Review and verify data sets as necessary.

  • Create, maintain and execute routine queries.

  • Prepare specific and ad-hoc management and operational reports.

  • Review and comprehend functional specifications and requirements for testing.

  • Create and execute tests scripts/cases to meet requirements of functional specifications and ensure proper system functionality and quality outcomes

  • Effectively solicit detail and request additional information from other business units as needed.

  • Promptly Report system testing issues from review and resolution and verify system set up and functionality of approved testing.

  • Are required input to IS to coordinate testing and production runs of reprocessing process.

  • Create files and submit run requests timely in accordance to SLA requirements and compliance

  • Troubleshoot and resolve issues with the test runs in coordination with other business units.

  • Coordinate finalization of errors with Claims management.

  • Track and trend on claims report statistics on SharePoint logs

  • Report and present preliminary findings based on trending and interpretation.

  • Assist in Claims Audit and processing and data look up as needed.

  • Conduct in accordance to regulatory and compliance guidelines and HIPAA

  • Other duties as assigned.

Minimum Qualifications:

  • High School Diploma or GED from an accredited institution

  • Experience with one or more of the following: querying data using data tables and ACCESS, identifying risks, issues and providing resolution options

  • Experience working in Microsoft product suite, including Outlook, Word, PowerPoint and Excel

  • Manipulation and creation of Excel spreadsheets; including but not limited to standardizing reports across multiple sheets, utilizing vLookups and functions/formulas, creating, using and interpreting pivot tables, filtering and formatting to generate desired results

Preferred Qualifications:

  • Bachelor's Degree from an accredited institution

  • Work experience in health insurance or healthcare environment

  • Knowledge of MHS and/or KIDS (State data system) preferred

  • Working experience with Child Health Plus and/or Medicaid programs, regulations and reimbursement

  • Working experience with NYSoH or Federal Exchange

  • Strong analysis and report development skills

  • Ability to demonstrate effective verbal and writtencommunication

Compliance & Regulatory Responsibilities: See Above

License/Certification: NA

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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