Senior Process Analyst - Claims Adjudication

enGen Global is an emerging global healthcare partner that delivers strategic innovation, expertise, and flexibility to its healthcare partners. Being a US healthcare conglomerate captive, we have direct access to deeper insights that help us accelerate our learning process and keeps us ahead of the curve. Thryve delivers next-generation solutions that enable our healthcare partners to provide positive experiences to their consumers.

Our global collaborative of healthcare, operations, and IT experts creates innovative and sustainable processes for our clients, which keeps the ever-evolving consumers engaged and assists them in managing the future of their healthcare better. We recognize that our people are our strength and the diverse talents they bring to our global workforce are directly linked to our success. Thryve is an equal opportunity employer and places a high value on integrity, diversity, and inclusion in the organization. We do not discriminate on the basis of any protected attribute.

Role Summary:

This job takes the lead in providing more complex claims adjudication services typically as part of a Operations team. Claims adjudicator usually analyze, validate, update, process and adjudicate claims to meet customer requirements that adhere to Highmark standards and policies.Claims Adjudicators provide general support to maintain TAT, meet SLA’s, performance and quality levels required by their customers. May mentor less experienced team members.

Essential Responsibilities:

• Analyzing, validating, updating & processing claims, as well as meeting defined scope, targets and SLA’s.

• Collaborating with customers, business analysts, partners, and IT team members to understand business requirements that drive the innovation and quality. Concentrates on providing innovative solutions to more complex business needs.

• Providing required support for new joiners once they gain experience.

• Performs work in compliance with all Highmark and Highmark IT standards, policies and procedures.

• Effectively communicates with team members, customers, partners and management, including assisting with or conducting more complex walkthroughs, reporting production & quality status.

• Other duties as assigned or requested.

The experience we are looking to add to our team

Required:

• Greater than 1.5 years of experience in claims adjudication

• Bachelor’s or Master’s degree in any discipline

• Good verbal and written skills

• Good analytical and interpersonal skills

Good to have:

• AHM or any equivalent certification

• Adjustments and Offset/Recovery knowledge