Job Description
Job Description
Job Description
Position Title: Carrier Relations Analyst
Department: Carrier Relations
Location: Remote
Reports to: Manager, Carrier Relations
Job Summary The Carrier Relations Analyst will play a key role in managing relationships with carrier partners and analyzing data to optimize carrier cooperation and performance in responding to issues conveyed via our unique referral, monitoring and resolution process. This role will involve leveraging data-driven insights to enhance the efficiency, cost-effectiveness, and reliability of carrier networks, ensuring smooth operations between the company and its partners. The ideal candidate will have strong analytical skills, a deep understanding of telecommunication and logistics operations, and excellent communication abilities to foster productive relationships with carrier partners.
This position is only open to legal residents of the United States of America who reside in the USA.
Key Responsibilities Carrier Management - Develop and maintain relationships with key carrier partners, acting as the main point of contact for day-to-day operations
- Collaborate with carriers to resolve issues, and manage service level agreements (SLAs)
- Monitor and evaluate carrier performance against KPIs and actionable agreements, addressing any issues that may arise
Clinical Data - A clear understanding of the identification and investigation of issues and billing activities leading to improper payments is required as this work involves reviewing medical claims data (professionals, facilities, insured members, or the broker community) in coordination with the customer’s carrier or third-party administrator.
- Utilizing information from claims data analysis, plan representatives and other sources to accurately present the company’s findings to carriers in a way insuring they will understand the issues and take recommended actions to remediate said inappropriate payments.
Process Improvement - Identify opportunities for process optimization within the carrier management function.
- Work closely with internal teams (Operations, IT, Finance, etc.) to implement improvements in the carrier management process
Qualifications Education & Experience - 4 – 6 years of experience in carrier relations, or a data-driven role
- 4 - 6 years working in a health insurance organization’s payment integrity area or employer group relations team
- Preferred Bachelor’s degree in a health, marketing or data science related field
Soft Skills - Strong interpersonal skills with the ability to cultivate and manage professional and productive relationships with external partners
- Excellent communication skills, both written and verbal, for report writing and presentations
- Strong analytical thinking with a problem-solving mindset and attention to detail
Key Competencies - Ability to analyze large sets of data to uncover insights and trends related to carrier actions relevant to company identified issues
- Strong time management and prioritization skills necessary to manage multiple carrier accounts and related tasks simultaneously
- Ability to work cross-functionally with various internal teams (IT, Finance & Operations) to improve carrier-related processes
- Critical thinking, attention to detail
Who is SmartLight Analytics? SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight identifies and combats issues leading to improper payment of health care claims through our proprietary data analytics and processes. Intentionally designed to require bare minimum client employer involvement, our process works behind the scenes to save money without interrupting employee access to their employer’s benefits.
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