Beneficiary Value Program Analyst
MCS Healthcare Holdings
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- Location
- San Juan, United States
- Job type
- Full time
- Posted
- Oct 13
- 7 days ago
Career path
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About the company
MCS Healthcare Holdings
Insurance · 1,001 to 5,000 employees
What you'll do
- Evaluate, report, resolve, and document processes related to member requests
- Perform member sampling to confirm deposits and purchases are recorded according to process
- Receive, handle, and document declined cards and keep the supervisor informed
- Generate low complexity reports to review different types of transactions
- Identify and assist in correcting internal or vendor transaction errors
- Reconcile and document differences between processed and approved totals
- Reconcile reports across different systems and communicate discrepancies
- Assess and resolve Grievances and Appeals cases
What you need
- Associate's Degree in Business Administration or at least 60 to 64 approved college credits
- At least one to three years of experience in Data Reconciliation and Analysis
- Spanish Basic (comprehensive, writing and verbal)
- English Intermediate (comprehensive, writing and verbal)
Key skills
Data Reconciliation and AnalysisSpanish BasicEnglish Intermediate
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Read the full posting here
GENERAL DESCRIPTION:
Responsible for handling, validating, and completing requests and reconciliations related to the Beneficiary Value Program. Assess program reconciliation and collaboration with cross-functional teams to enhance overall program performance to ensure that the Beneficiary Value Program goals align with the company objectives. Accountable for completing all tasks related to transactions between the company's internal systems and other vendors' required systems.
ESSENTIAL FUNCTIONS:
•Evaluate, report, resolve, and document in the designated system all processes related to the requests received by the members and comply with the performance metric regarding the Beneficiary Value Programs.
•Performs member sampling in the designated systems to confirm that deposits and purchases are recorded according to the established process.
•Escalates with the direct supervisor any evidence of possible utilization or attempted fraud, financial exploitation, or misuse of the benefits that may be detected while evaluating the requests received by the members.
•Receives, handles, and documents declined cards and keeps the direct supervisor informed of transaction status.
•Generate low complexity reports to review different types of transactions (purchases, deposits, cards, among others).
•Identifies and assists in correcting situations or error reports related to internal transactions or with the vendors involved in this process.
•Reconciles, identifies, and documents any differences between processed and approved totals.
•Perform various reconciliations of reports across different systems and proactively communicate to the direct supervisor the findings or discrepancies in reconciliations or errors between these reports.
•Completes special projects related to the balances, cards, cases, or reconciliations of the Beneficiary Value Programs.
•Receives, documents in the designated system, and appropriately channels the returned correspondence related to the Beneficiary Value Program.
•Assess and resolve Grievances and Appeals cases received, ensuring compliance with the standards and policies established by the unit.
•Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
•May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience: Associate's Degree in Business Administration or at least sixty to sixty-four (60-64) approved college credits. At least one (1) to three (3) years of experience in Data Reconciliation and Analysis.
"Proven experience may be replaced by previously established requirements"
Certifications / Licenses: N/A
Other: N/A
Languages:
Spanish Basic (comprehensive, writing and verbal)
English Intermediate (comprehensive, writing and verbal)