Job Description

Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.
Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.
We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
Position summary
As a critical team member of the Payment Integrity team partnering with Health Plan Services (HPS) this role helps to support the analytics and reporting for Payment Integrity Services. The Analyst for Payment Integrity is responsible to support the needs and direction of the Claims Discovery Leader and priority initiatives for payment integrity related to existing HPS clients. Given the nature of the role, (s)he is expected to employ a consultative and analytical approach to issue resolution.
This role is an ideal fit for someone who enjoys working in a fast-paced, hands-on, client-facing environment with a heavy focus on cross functional operations and process improvement. This individual also helps track performance against SLA’s and other key performance indicators.
This is role is meant to be a foundational starting point to develop and launch outstanding talent and future leadership into the HPS organization. Reporting to the Associate Director, Payment Integrity and has multiple career path options to grow into.

Essential functions

• Support the Payment Integrity Team reporting needs, e.g.:
  • Retraction files (promoting uniformity for data load)
  • Monthly membership file
• Assist with developing and maintaining:
  • Financial reports
  • Executive status reports
  • Standard stack of Payment Integrity related reports
• Build Payment Integrity data warehouse tables that support multiple clients and functions
• Generate ad hoc data analysis as needed
• Develop and standardize the identification of in-house audit Concepts
• Build user guides for newly created analytic processes
• Support business goals & system fixes by claim reviews, analyzing, identifying, and resolving issues
• Participate in documenting and prioritizing potential solutions to issues & fallout for system issues
• Establish and implement interim workaround solutions as needed and communicate to all impacted users
• Effectively handle multiple initiatives as the same time
• Other duties as assigned

Mandatory Skillsets:

• Good understading of US healthcare.
• Critical thinking skills to build efficiencies
• Reviewing member claims to determine if claim is a high dollar claims, refund is posted and Refund letters are mailed.
• Review recalc projects (over/under paid claims) to determine if refund is valid and post accordingly in system.
• Work various reports and queues to determine overpayments
• Write/track and mail recovery letters
• Generate ad hoc data analysis as needed
• Develop and standardize the identification of in-house audit Concepts

Good to have Skillsets:

• Highly proficient in MS Excel, MS Access and MS Word
• Strong background in accounts receivables
• Ability to find and suggest solutions with little or no guidance
• Strong financial reporting skills

Academic Qualification

• Associate or Bachelor degree preferred.
• Experience in health insurance claims processing
• HMO Claims or managed care environment preferred.

Mandatory Requirements:
Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Preferred Requirements:
Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.