MCR Support Analyst

October 2

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NJM Insurance Group

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Auto Insurance • Workers'​ Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance

1001 - 5000

Description

• This full time, dedicated position is accountable for supporting MCAP (Medical Cost Initiatives) through feasibility study, savings analysis, contracting, implementation, post-installation monitoring and monitoring and reporting of actual savings for MCAP initiatives in HCM • Provide analytical, implementation and reporting support to the HCM MCAP Initiatives Director • Lead the vetting, implementation and reporting of multiple Medical Cost Maximization projects • Research market trends and engage vendors to assess opportunities • Collaborate with Vendor, Sourcing, IT Security and Legal in the development of agreements required for external opportunities • Collaborate with Analytics, Vendor(s) and Actuarial to gather and compile data requirements • Coordinate Solution Options, Planning Approximations and Implementation Timelines with IT BSG and EPMO liaisons • Plan, forecast, develop recommendation, seek funding for and oversee implementation of changes within the Medical Cost Maximization, Delegated arrangements and Vendor oversight • Ensure that savings and ROI models are up to date, maintained and aligned with the initiative scope and communicates risks and reflected in the MCAP reports

Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Project management experience or participation as a key Subject matter Expert (SME) is a plus • Requires broad-based experience with a minimum of 5 years in managed healthcare or related industry • Successful track record in managing operations with process improvement background desired • Claims systems knowledge is preferred • Past experience on system implementations in a fast-paced, high pressure environment is preferred • Experience with specialty health plan products and vendors preferred • Requires broad understanding of claims systems and related ancillary systems • Requires business and/or technical expertise from previous claims projects and work flow changes and impacts • Requires knowledge of a claim processing system such as NASCO system and other ancillary support systems such CareRadius, Ncompass, Sharepoint, Clearquest or other similar systems • Requires knowledge of project management life cycles and related tools and practices • Must have a good understanding of Utilization Management processes, Medical Policy Application, claim processing including pricing • Must have strong organizational and analytical skills and demonstrated ability to effectively manage multiple projects at one time • Must have strong inter-personal skills with a demonstrated ability to lead cross-divisional work teams • Must demonstrate an understanding of the interdependences between the business, clinical and financial side of the health care business • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint, MS Project) • Should be knowledgeable in the use of intranet and internet applications • Must have a working knowledge of the impacts of mandates and legislation on overall claims processing and contracting

Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement