Senior Client Set Up Analyst || Philadelphia, PA || Hybrid

The Senior Client Setup Quality Analyst participates in pre- and post-implementation audits of client benefits and setup. This role involves preparing accurate claims test scenarios, conducting comprehensive group setup audits, and ensuring compliance and accuracy for medical products, including ancillary setups. The analyst will effectively document and review audit results to ensure benefits comply with setup requirements and client contracts, while also assisting the Configuration team with benefit plan development.

Location : Philadelphia, PA (Hybrid: 3 days onsite, 2 days remote)
Contract to hire

Key Responsibilities:

• Participate in internal and external audits.
• Collaborate with Client Implementation, Sales, and Audit teams to define the scope and timeline for auditing client benefits and setups.
• Identify setup issues, trends, and process improvement opportunities through audit findings.
• Conduct audits of client setup documents, including specific benefit templates.
• Document and communicate audit findings, summaries, and comprehensive reports to the Audit and Sales teams.
• Audit client benefit changes, administrative changes, and cancellations per established Client Setup and Underwriting Guidelines.
• Ensure necessary documentation is received, product information is accurate, and rates are confirmed before group approval or processing benefit changes.
• Meet departmental production standards and quality requirements.
• Track and document assigned inventory accurately.
• Respond to inquiries regarding departmental procedures/policies from Account Executives, Client Setup, Brokers, Enrollment, and Billing.
• Resolve issues related to group setup and benefit changes promptly and effectively.
• Maintain positive client relationships with internal and external customers and Account Executives.
• Participate in special projects related to customer implementation and changes.
• Recommend process changes to enhance departmental efficiency.
• Perform additional duties as assigned.

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Qualifications:

• Education:

  • Bachelor s degree preferred; or 3-4 years of relevant experience in lieu of a degree.

• Experience:

  • Minimum of 4 years of relevant experience required; Benefits and Claims experience preferred.
  • Auditing and quality review experience required.
  • Experience with HealthRules Manager/Designer preferred.

• Knowledge, Skills, Abilities:

  • Extensive knowledge of audit processes and documentation organization.
  • In-depth understanding of healthcare products, benefits, and systems.
  • Proven ability to manage project targets and deadlines effectively.
  • Strong independent work capabilities.
  • Ability to audit client documents for accurate benefit and product setups.
  • Flexibility and adaptability are essential.
  • Willingness to cross-train and assist team members.
  • Excellent communication skills for interaction with all management levels and external clients.
  • Strong time management and organizational skills to prioritize workload in a fast-paced environment.
  • Knowledge of systems, process flows, regulatory impacts, and compliance timelines.
  • Skilled in trend analysis with effective communication to business partners regarding findings and recommendations.
  • Strong problem-solving abilities, with a capacity for issue resolution.
  • Understanding of benefits and underwriting rating methodology, with the ability to apply Underwriting guidelines.
  • Proficient with HealthEdge applications (HealthRules) or similar benefits/claims processing software.
  • High technical aptitude, including proficiency in Microsoft Office (Word, Excel, PowerPoint) and the ability to learn proprietary and vendor systems.

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