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Benefit Analyst Consultant (Ea...


Job Summary

Eagan, MN
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Benefit Analyst Consultant (Eagan or Gilbert, MN)- PS4644

About the Job


The Benefit Analyst Consultant role is responsible for serving as the liaison between the Utilization Review, Operations and IT departments in translating complex business needs into application software and benefit rule setup in the claims systems.

Primary duties may include, but are not limited to:

  • Analyzes requested changes to benefit rules around frequencies and limitations for impact on claims processing systems and/or review or operational areas.
  • Setup up new benefit rules in the system for new product roll-outs, annual CDT changes, and other benefit related changes.
  • Determines specific business application software requirements to address complex business needs not accommodated by current system functionality.
  • Works with programming staff to ensure requirements will be incorporated into system design and testing.
  • Communicate status updates to internal management and external TPA customers
  • Acts as a resource to users of the software to address questions/issues.
  • Develop acceptance criteria/test cases for system projects and lights on work and complete associated user acceptance criteria.

Work with front line business units to support operational readiness.

Support other system enhancements as requested in a similar manner.

  • Requires a BS/BA degree, 5-7 years of related business analysis experience that includes knowledge of claims processing, systems capabilities, business operations, experience with user acceptance test development and execution as well as operational readiness methodology; or any combination of education and experienced, which would provide an equivalent background.
  • Registered Dental Assistance or equivalent dental clinical experience.

Preferred skills/experience:

  • Health insurance background required, with a focus on claims processing and associated rules
  • Strong analytic skills and attention to detail
  • Research issues, monitor, track, and find resolution
  • Ability to be the liaison between IT, Utilization Review and Operations production teams
  • Looking for strong business experience with a high level technical understanding.
  • Strong experience with development and execution of User Acceptance Testing
  • Strong verbal, written, presentation skills
  • JIRA experience submitting tickets and test cases nice to have.

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