We are seeking an experienced Health Insurance Analyst to support cross-functional operational initiatives, benefit implementation efforts, and quality assurance activities within a healthcare environment. This role combines project coordination, business process improvement, and quality review to ensure client implementations, benefit configurations, and operational processes are accurate, compliant, and delivered efficiently.
The ideal candidate has experience with HealthRules, healthcare benefits or claims operations, and enjoys collaborating with multiple teams to improve processes, resolve issues, and support successful implementations.
Key Responsibilities
Coordinate cross-functional activities to support operational initiatives, client implementations, and process improvements.
Collaborate with internal teams, vendors, and stakeholders to ensure projects and operational activities remain on schedule and meet business objectives.
Perform quality reviews and audits to validate the accuracy of benefit configurations, claims processing, and client setup activities.
Develop and execute test scenarios to verify benefit setup and identify configuration issues before implementation.
Analyze audit findings, identify trends, recommend corrective actions, and drive continuous process improvements.
Monitor project progress, identify risks and issues, and communicate updates to stakeholders.
Develop and maintain documentation including policies, procedures, workflows, training materials, and audit reports.
Facilitate meetings by preparing agendas, presentations, meeting minutes, and action items while ensuring timely follow-up.
Partner with Client Implementation, Configuration, Claims, Sales, Product Management, and Operations teams to resolve issues and improve operational efficiency.
Ensure compliance with organizational policies, underwriting guidelines, regulatory requirements, and quality standards.
Support special projects related to operational readiness, benefit changes, system enhancements, and client implementations.
Qualifications
Required Experience
3–5+ years of experience within a health insurance or managed care organization.
Experience with HealthRules Manager/Designer or similar benefits administration platform.
Background in benefits configuration, client implementation, claims auditing, quality assurance, or healthcare operations.
Experience coordinating projects, leading cross-functional initiatives, or serving as a Project Lead or Business Analyst.
Knowledge of healthcare benefits, claims processing, audit methodologies, and regulatory requirements.
Preferred Skills
Strong analytical, problem-solving, and organizational skills.
Experience identifying process improvements through audit findings and operational analysis.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Excellent verbal and written communication skills with the ability to collaborate across all organizational levels.
Proficiency with Microsoft Office Suite, including Excel, Word, and PowerPoint.
Experience developing documentation, reports, training materials, and process workflows.

Health Insurance Analyst

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