Benefit & Claims System Tester Job at Avesis, Incorporated
Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
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.
Reporting to the Director of Data Integrity, the Benefit & Claims Plan System Tester will conduct a variety of audits and test scenarios in Avesis’ systems designed to determine whether health plan and provider information flows and produces the desired results for benefit coverage, specific levels of payments for providers, member benefit payment accumulators, and claims processing - as intended for each contracted health plan and employer group. This individual will work closely with the Plan Designers, Claims Department, and other applicable staff in the course of conducting the systems testing for new and existing health plans to ensure that all possible scenarios that may be experienced are tested and that health plan build-outs are validated. This role also ensures that applicable corrections to the plan are incorporated. In other interdepartmental initiatives, the Benefit & Claims Plan System Tester will work closely with other Avesis departments to troubleshoot and improve other related automated processes.
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.
Essential Job Functions:
- Develop detailed test scenarios for Avesis systems for all new plans or benefit changes
- Working with plan designers regarding any benefit issues found during testing or identified by other team members
- Working closely with the Claims department staff regarding any potential claims adjudication issues
- Assisting Avesis departments in correcting provider issues relating to claims
- Working with business analysts and other team members on claims encounters, issues and implementation of new groups.
- Assisting other Avesis departments regarding questions or issues with plan benefits
Requirements:
- Bachelors or Associates degree in a related field is preferred; High School Diploma or GED required
- Prior claims processing experience
- Knowledge of Medicare, commercial and Medicaid insurance and CPT and ICD-9/10 codes
- Excellent written and verbal communication skills
- Strong skills in using Microsoft Office applications and other windows-based applications
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, 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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