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Job Overview

Category

CA, CFA, CMA, MBA, MCOM/BCOM

Job Role

Finance Executive

Gender preferred

No Preferences

Work preferred

Work from Office

Qualification

Graduation

Any Graduation

Post Graduation

Any Post Graduation

Description



Your Future Evolves Here



Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference
working in everything from scrubs to jeans.



Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.



We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.



What You’ll Be Doing:



Position summary



This position requires maintaining accurate member records. Entering system eligibility and/or enrollment data on a daily basis including new enrollees, change in circumstance terminations, PCP’s and broker information.



Essential functions



  • Research 834 X12 Files

  • Display proficiency in working in Excel (sorting, updating records required; vLookup and Pivot Table experience preferred)

  • Adjusts premiums and rates for financial billing as directed/required

  • Correspond and communicate with the groups, brokers, and clients.

  • Generate reports as needed (i.e. daily, monthly, and /or year-end).

  • Remain informed of developments in area of expertise by attending conference calls, webinars, reading pertinent literature and so forth.




Key competencies/skill/success factors:



  • Understanding of X12 files, 834 files, paper enrollment, and billing/invoicing.

  • Understanding of Enrollment member domain platform and processing member records and knowledge of Medicaid, Medicare Advantage and Commercial member enrollment domain process/concepts.

  • Reports to the Enrollment Supervisor/Manager, working closely with multiple departments within the organization such as Product Development, Claims, Client Finance & Billing, Training team and Provider Services.

  • Providing floor support and assisting team members with their queries and are always available or take additional responsibilities.

  • Performing the research on the member records to identify the possible issue and fixing the same

  • Creates process documentation and P&P in collaboration with process trainer to support and describe business initiatives.

  • Participate in cross team calibration calls as a senior representative from the team.

  • Experience in process improvement that utilizes six sigma, kaizen, and/or other process improvement methodologies in a transactional environment or has experience in being involved in process improvement in general that tie into measurable results.

  • Overall understanding of health care benefit administration.

  • Ability to communicate in an effective manner to drive results and maintain positive team atmosphere.

  • Ability to communicate to other internal business teams during cross-functional projects and ability to implement conflict resolution strategies.

  • Ability to document processes and/or provide guidance to business analyst to ensure proper documentation is developed.

  • The interpersonal skills necessary include the ability to work well within a team that includes all levels within the organization from clerical and support staff to senior management as well as clients and brokers outside of the organization.

  • Understands working in a health benefit administration, Third Party Administrator, or Pre-Tax Benefit environment

  • Understands and can work in a production environment in which performance is tied to operational metrics

  • Integrity and discretion to maintain confidentiality of member’s HIPAA data.

  • Strong analytical ability necessary to work, discover and outline systems related issues on own as well as within a team.

  • The ability to take the lead on projects and recommend and implement process to complete work.

  • Proficient in MS Excel and MS Word.




Qualification and Experience:


Required



  • Should be on Sr Associate role for atleast 2 years.

  • Should be ready to work in shifts/weekends if required

  • Should be good with MS-Office

  • 4 year College degree or equivalent work experience

  • Knowledge of health insurance operations




Mandatory Requirements:


Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.



Preferred Requirements:


Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.






Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.


Skills

ResearchExcelCommercialFinance

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