Episode Support Analyst

HealthMarkets Administrative Services Group is a wholly owned subsidiary of HealthMarkets.  HealthMarkets is based in North Richland Hills, Texas and is a leading innovator in the health insurance industry. Through consumer guided insurance plans, underwritten by its insurance subsidiaries, HealthMarkets seeks to provide affordable and accessible health insurance to individuals and small businesses nationwide.  HealthMarkets Administrative Services Group provides service to customers of our Consumer Advantage Plans underwritten by The MEGA Life and Health Insurance Company (see www.megasmallgroup.com) and Chesapeake Consumer Choice Plans underwritten by The Chesapeake Life Insurance Company, another subsidiary of HealthMarkets (see www.chesapeakeplans.com). For more information regarding HealthMarkets and its subsidiaries, visit www.healthmarkets.com.

 

 

We offer dynamic and challenging opportunities to those who want to make a difference. We?re searching for energetic, creative and self-reliant professionals for exciting career opportunities in our Norwalk, CT location of HealthMarkets Administrative Services Group. We have assembled a strong team of professionals dedicated to designing and improving health insurance plans for consumers. We value vision, passion for excellence, creativity, and a ?roll-up-your-sleeves, can-get-it-done? attitude. We offer an outstanding workplace environment. Our office is modern and spacious, boasting a congenial atmosphere, cutting-edge technology and diversity.

 

The Episode Support Analyst?s main responsibility is to act as a first line support resource for the Company?s Episode based product(s). This includes, but is not limited to:

1.  Researching and responding to second level SmartFund related member/agent/provider inquiries via the Complaint, Appeals & Grievance process,

2. Actively being involved in data verification while performing SmartFund claim reviews,

3. Participating in Quality Assurance testing of Episode product metadata content and functionality testing of the Episode Management Program,

4. Performing routine review, analysis and follow-up of scheduled SmartFund generated reports, and

5. Assisting with documentation and maintenance of workflow processes.

 

The successful Episode Support Analyst will have a medical billing/claims background (LPN or Certified Coder a plus), proven knowledge of medical terminology, and a background in the health insurance industry.  The Analyst must be a detailed oriented individual with strong analytical skills and working knowledge of medical coding conventions such as CPT/HCPCS Level II and ICD-9-CM Diagnoses and Procedure codes.  The Episode Support Analyst must be

able to work with multiple desktop/web based applications concurrently and use a systemic approach to identifying and solving problems. This highly organized individual must have the ability to look beyond the obvious and seek the root cause of a potential problem. The ability to easily adjust to changing requirements and priorities is a must!