Lead Claims Analyst

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in six Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

Our Human Services team helps state and municipal human services and economic development agencies keep their promises—responsibly and sustainably—to the children, adults, and families they serve. Join us and use your professional skills to build stronger communities and better serve populations in need by making meaningful and lasting changes in government organizations.

Services:

• Program Consulting
• Finance Consulting and Billing Services
• Applied Technology
• Outsourcing and Operations
• Strategy
• Project and Grants Management
• Assessments and Feasibility Studies

Analyzes claims for accuracy, provides client support, documents inquiries, supervises staff, prepares reports, ensures compliance, conducts training, and assists with quality control and process improvements.

Duties and Responsibilities

• Analyzes and reviews claims for accuracy, completeness and eligibility.
• Provides leadership, supervision and coaching to junior department staff.
• Prepares and submits claims data for multiple clients within multiple states.
• Analyzes the development of claims assigned at each level of the adjudication process.
• Provides support and give direction to less experienced staff
• Evaluate medical records and apply evidence to each case.
• Provides monthly reporting statistics.
• Ensures adherence to claim timeliness and accuracy performance standards.
• Prepares for and participate in various meetings, including status reports, process improvement meetings and meetings related to collection of required data.
• Conducts policy and other research.
• Assists with quality control projects, including case reviews to ensure the integrity of claim methodology and eligibility determinations.
• Assists with preparation of other written reports and materials for clients.
• Assists in administration of time studies and operation of help desk lines.
• Trains others on the function of analyzing claims.

Required Skills

• Ability to evaluate, coordinate and perform a complex set of planning, development and administrative tasks.
• Ability to build and maintain working relationships with federal, state and county agency staff.
• Strong Microsoft application skills.
• Ability to work with a large volume of claims and effectively prioritize the workload.
• Excellent organizational, oral presentation and written communication skills.
• Strong analytical skills, including the ability to analyze and organize data.
• Ability to work both in a team situation and autonomously.
• Existing knowledge or experience with state government, health insurance payment systems (particularly Medicaid), and/or cost accounting are highly advantageous.
• Knowledge and understanding of appropriate laws and regulations and applicable government agencies
• Overtime and travel might be needed at times.

Qualifications

• Bachelor’s degree in a relevant field is preferred
• 6+ years of relevant claiming experience is required. Previous leadership experience is preferred.

Working Conditions

• Office Setting

The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of personnel so classified.

PCG provides the following reasonable range of compensation for this role: $63,600.00 - 87,000.00 - and a potential discretionary bonus of up to 10 %

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Compensation:

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience.  As required by applicable law, PCG provides the following reasonable range of compensation for this role below. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.

EEO Statement:

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.