Configuration Quality Specialist

Join us for an exciting career with the leading provider of supplemental benefits!

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Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

The Configuration Quality Specialist at Avesis LLC is responsible for testing the accuracy and completeness of our benefit plans within our claims processing system. Working side by side with the plan designers, we are the first step in ensuring a great product for our customers.

The Plan Configuration team manages the data within our claims processing system to create benefit plans. We. The specialist will work collaboratively with the System Configuration Specialists, Claims Department, and other applicable staff while conducting the quality review health plans to ensure that all benefit scenarios are tested and validated, and that applicable corrections to the plan are incorporated.

The Configuration Quality Specialist will use their strong skills in claims processing and understanding of system configuration, to conduct a variety of audits and test scenarios in Avesis’ systems to determine whether health plan and provider information follows prescribed paths to achieve optimal results for benefits, accumulators, provider payments, and processing rules for each contracted health plan and employer group.

Competencies

 

Functional:  

•  Develops and executes detailed test scenarios for Avesis systems for all new plans and plan changes. 
• Accurately reviews and documents system configuration to validate accuracy. 
• Work independently to create test scenarios for new plans or plan changes within 3-5 days of receipt unless otherwise stated.  
• Works closely with System Configuration Specialists to resolve failed test scenarios. 
• Completes department tasks accurately and timely. 
• Regularly Attends and actively participates in department and company meetings as needed. 
• Continuously identify areas of improvement to enhance quality and efficiency of Configuration Quality Specialist role. 
• Works closely with the Claims department staff to facilitate resolution of any claims adjudication issues. 
• Produces accurate and timely reports (claims, fees schedules, providers, members)   
• Assists Avesis departments in timely correction of claims related issues.  
• Works with business specialists and other team members on claims encounters and implementation of new groups. 

Core:  

•  Strong proficiency in Microsoft excel, sorting, importing flat files as well Word and Outlook. 
• Ability to read, write, and communicate at a professional level.
• Capacity to manage multiple tasks and prioritize effectively. 
• Excellent time management and organizational skills. 
• Willingness to work overtime as needed. 

  

Behavioral:  

•  Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.   
• Initiative: readiness to lead or take action to achieve goals.  
• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.  
• Member-focused: going above and beyond to make our members feel seen, valued, and appreciated. 
• Detail-oriented and thorough: managing and completing details of assignments without too much oversight. 
• Flexible and responsive:  managing new demands, changes, and situations. 
• Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task. 
• Integrity & responsibility:  acting with a clear sense of ownership for actions, decisions and to keep information confidential when required. 
• Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties. 

 

Minimum Qualifications:  

•  High school diploma or equivalent. 
• 5 years progressive experience in Healthcare Administration or related field preferred. 
• 1-3 years of experience managing multiple projects simultaneously while delivering results according to timelines. 
• 1-3 years of experience working in a fast-paced, rapidly changing environment.
• As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 25Mbps upload while hardwired and not on a VPN are sufficient. 

  

Preferred Qualifications:  

•  5 years or more claims healthcare experience.
• 3-5 years EDI file experience .
• 3-5 years of experience with ICD-10, CDT, CPT and HCPC codes.  
• 3-5 years of Medicare, Medicaid, and commercial claims processing and benefits. 

 

FLSA Status: Hourly/Non-Exempt

Salary Range: $22.15 - $34.64 per hour.

How To Stay Safe:

Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during our process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avēsis, We See You.  We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic.  At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients.  We focus on recruiting, training and retaining those individuals that share similar goals.  Come Dare to be Different at Avēsis, where We See You!

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