Grow your career at APWU Health Plan
APWU Health Plan is a great place to work. We offer a competitive salary, health insurance—including dental and vision—401(k), generous vacation leave, and tuition reimbursement.
Utilization Analyst
The APWU Health Plan is seeking a Utilization Analyst to join our Utilization Management Department. This position assures the Health Plan remains competitive by identifying, designing, recommending, implementing and evaluating health care programs that control utilization and benefit expense.
Primary Accountabilities:
- Identify and seek out potential programs and vendors that support utilization management and makes recommendations to senior staff on initiatives and strategies that support the corporate mission.
- Advise on industry trends and identifies the need for new or revised utilization management programs and practices.
- Direct quarterly trend reviews and forecasting analysis
- Other duties as assigned.
Qualifications:
- BA/BS degree and three to five year’s health insurance experience.
- LPN or RN certification preferred.
- Ability to define data and information needs; compile, analyze and interpret data relative to healthcare utilization.
- Ability to write reports, recommendations, business correspondence, scope of work, project plans, policies and procedures. Ability to effectively present information to Health Plan Management and effectively communicate with vendor/partners and members.
- Experience with medical benefit management and plan design, pharmacy benefit management and plan design, medical coding, medical and behavioral case management, familiarity with medical and pharmaceutical policies and industry standards.
- Detail oriented with strong analytical, presentation and research skills a must.
- Strong performance management skills in managing external partners, communicating clear goals, performance measurements, etc.
- Demonstrated ability to identify problems, collect data from various sources and determine the appropriate action.
- Multi-disciplinary project management skills.
- Excellent computer skills to include Microsoft Office, internet research and Ad hoc query and reporting.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Applications Programmer I
APWU Health Plan is seeking an Applications Programmer I to join our Applications Development Department.
NATURE AND SCOPE
- This position reports to the Team Lead, Applications Development.
- This position is responsible for developing accurate and efficient computer programs adhering to established standards. The incumbent is responsible for changes/enhancements to existing systems.
- This position will interface with users and Business and System Analysts as well as vendors and subject matter experts in designing systems or enhancements or correcting defects found during uses.
- The incumbent will work with others as needed to obtain or create test data as required to validate system changes/enhancements.
RESPONSIBILITIES
- Assist in the development of computer programs including the testing of the finished program before formal testing and production turnover.
- Responsible for daily EDI review and correction for inbound transactions including but not limited to 834, 837, 277, proprietary and flat files.
- Work according to the direction of or project plans laid out by the Team Lead, Applications Development, Manager Application Development or their designee.
- Perform other duties as requested.
REQUIREMENTS
- Associates degree in related field preferred but 2 years of direct experience may be substituted.
- Familiarity and understanding of HTTP/FTP/SFTP concepts.
- Knowledge of CAQH CORE requirements, HITECH, ACA and other government mandates.
- Experience in SQL Server, Visual Studio, ASP.NET, C# and development tools for ETL a plus.
- Experience with health insurance systems, claims processing systems, financial systems, budget and expense systems and utilization systems a plus.
This is a union position.
To apply
- All stated requirements must be clearly reflected in your resume or specifically addressed in your cover letter.
- Stated salary requirements (range is acceptable) are required for consideration.
- Experience in a Union environment preferred.
- No relocation assistance available.
- Must pass criminal records check and drug screening prior to employment.
EOE M/F/D/V; Drug-Free Employer
Note to agencies
We do not accept unsolicited resumes from third-party vendors. Only resumes received from contracted agencies/vendors will be considered. Unsolicited resumes sent to APWU Health Plan will not be recognized and such agency will have no recourse from APWU Health Plan.