Group Set Up Analyst I

Company Name:
Premera Blue Cross
Job Summary:
At Premera Blue Cross , a _ Group Set Up Analyst I _ is responsible for analyzing, coding, and implementing the standard contract benefit plan provisions, determining appropriate programming criteria, and applying specific system coding logic that interprets correct plan, billing and commission arrangements on standard new and renewal group processing. The person is responsible for maintaining Group Set Up databases. S/he will partner in developing and maintaining documentation regarding group specific and specialized plan design features and may serve as a Premera resource for troubleshooting standard issues related to plan coding, interpretation, and application. The coding of the entire group structure includes but is not limited to loading the group application, indicative, class plan, network sets, rates & calculations, billing entity, broker commissions & calculations, related entities, admin rules, contacts and product coding load.
1. Analyzes and gathers source information and contract language from partner sections (Sales, Underwriting, Product/Benefit Configuration) to determine the appropriate data elements to be applied and entered into the Facets system for the accurate adjudication of plan benefits, products, billings and commission arrangements, to support output in Claims, Customer Service, Broker Relations and Membership & Billing.
2. Performs research related to group setup and coding requirements, and creates and maintains documentation of coding for assigned groups.
3. Organizes, prioritizes and balances numerous concurrent projects to achieve department, corporate, external audit review and Member Touch Point Measures (MTM) accuracy and timeliness goals. Measurement tracking includes output success in ID card generation, membership billing and the web display of product and eligibility information. Person will update and maintain appropriate databases for collection of department and corporate audit statistics.
4. Finalizes work efficiently & communicates appropriate handoffs to support timely member enrollment & fulfillment output. This is done via appropriate system tools, including ID card audit reports (excel), DGTT (Dimensions Group Tracking Tool - web), and group level notes.
5. Researches, documents and responds to questions, and troubleshoots and resolves basic problems related to Group Set Up for Premera business units.
6. Conducts 100% daily peer review quality audits to ensure that Group Set Up matches the contract(s). Discrepancies are researched with Sales, Underwriting, and Product Configuration for correct information; necessary revisions are documented and implemented to Group Set Up.
7. Analyzes plan designs and plan changes for new or revised benefit plans and new or renewing groups to determine if system enhancements are needed in collaboration with Sales.
8. Meets with clients and effectively communicates either telephonically, by email or in person to discuss group set up requirements and billing criteria or to resolve any group set up client issues.
9. Help maintain basic system data accountability to assure all requests from upstream partners are tracked and accounted for in contract documentation, including but not limited to SMART system, AGL lookup tables, read & reporting basic SQL reporting output concerns, Facets, and Dimensions Group Tracking Tool.
10. Able to audit non-standard work with TSS or GSU Analyst 2 & 3 partnered support.
11. Performs other duties or special projects as assigned.
Minimum Qualifications:
1. Minimum of 1 year related healthcare experience
2. Strong knowledge of Facets or health-care delivery systems
3. Extensive experience in automated information processing & production environment.
4. Learns, retains, and applies a vast amount of information quickly in a changing production environment.
Additional Qualifications Preferred :
1. Strong attention to detail; demonstrated ability to maintain a high level of accuracy and efficiency in a production environment.
2. Demonstrated ability to effectively manage and balance a high volume of work and a variety of tasks; ability to prioritize urgent issues effectively.
3. Experience in interpreting contract language between systems.
4. Effective verbal and written communication skills; ability to establish and maintain favorable business relationships; ability to work well independently and in a team environment.
5. Exhibits a drive for continuous improvement; is highly proactive in setting self standards, goals and work achievements; adapts easily to change.
6. Strong PC proficiency, including with MS Suites (Excel, Outlook, Word, Access)
7. Experience with the SMART Sales application, Benefit Coding or the Auto Group Load (AGL) functionality.
8. Demonstrated ability to understand technology related interactions between systems (e.g. fields, tables, databases, technical structure)
9. Able to effectively manage multiple production groups and projects at once.
Working Conditions:
Work is performed within a normal office environment with ambient temperatures and involving occasional reaching, stretching, bending and moving about.
EOE - Equal Opportunity Employer. Minorities, women, veterans and individuals with disabilities are encouraged to apply.
Job Title: Group Set Up Analyst I
Job ID: 9311
Location: Mountlake Terrace, WA
Full/Part Time: Full-Time
Regular/Temporary: Regular

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