Medicare Operations & Reconciliation Analyst

Analytics


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina through our affiliate, Eon Health (redirects to Eon).

Group1001 is on a mission to empower consumers. Our family of companies share a common goal: giving people more control over their money, making it easier for them to do businesses with us, and creating more opportunities for them to see value every day.

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture.

One of the goals for Group1001 is to foster a great culture.  Group1001 will continue to build a culture that emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets, employees. 

 

Job Summary

Under the supervision and direction of the Director, Enrollment & Member Services the Operations & Reconciliation Analyst is responsible for producing operational reports, performing analytics and working and reconciling the membership data. The Operations & Reconciliation Analyst will execute day to day business processes and full monthly reconciliation to ensure compliance with the Center for Medicare and Medicaid Services guidance and CSH’s enrollment and reconciliation operations procedures/protocols.

 

Main Accountabilities:

  • Create advanced queries and reports that extract data to support business teams’ needs using SQL, Microsoft Excel, or other analytics tools.
  • Develop analyses requiring the integration of multiple data sources such as enrollment system, customer relationship management system, and CMS files.
  • Compare plan membership files with daily and monthly CMS reports to identify discrepancies.
  • Research and interpret identified discrepancies to ensure system is updated with accurate membership information.
  • Prepare the enrollment and payment reconciliation report used for the quarterly CMS membership attestations.
  • Assists with other duties as assigned.

 

Qualifications:

  • Associates Degree in a related field or equivalent combination of education and experience.
  • 1+ years experience with CMS Medicare Enrollment/Eligibility and/or and/or general knowledge of member eligibility functions and data management.
  • Familiarity with writing SQL queries for the purpose of analyzing data and establishing business rules and requirements
  • Proven decision-making skills and ability/willingness to multi-task in a fast-paced environment.
  • Strong organizational and time-management skills.
  • Ability to multi-task, good organizational and time management skills.
  • Must be able to work and act independently and be self-directed.