ARE YOU AN APWU BARGAINING UNIT EMPLOYEE?

Join the APWU Health Plan team

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.

APWU Health Plan, a health insurance company located in Glen Burnie, MD, is seeking a Communications Clerk.

RESPONSIBILITIES

  • Responding to phone inquiries regarding healthcare eligibility and coverage questions.
  • Must be able to decipher complex eligibility information from a variety of electronic sources quickly, and deliver them courteously and effectively to our largely senior membership population.
  • This is a high volume call center position subject to high production and quality standards.
  • Performing related duties, as requested.

REQUIREMENTS

  • Two years customer service experience, health insurance preferred.
  • Proficiency in a windows environment.
  • Excellent listening and communication skills.
  • Must have stable work history.

Successful candidates must be able to work multiple shifts, to include 11:30 p.m. to 7 a.m. This position is a work at home position after successful training and probationary period. This is a Union position.

Apply Now

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.

APWU Health Plan is seeking an EDI Analyst to join our Applications Development Department. The incumbent supports and enhances the quality of production operations through on-line maintenance of EDI and integrations to core claims systems, recommending and implementing improved methods/alternatives for operations.

RESPONSIBILITIES

  • Analyze, create, maintain EDI transactions and inbound and outbound proprietary files.
  • Assist in maintaining benefits, configuration and fee schedules in QNXT.
  • Conduct testing of system changes. Actively participate in QNXT system upgrades.
  • Perform troubleshooting, create the root cause analysis, and propose solutions for issues found in:
    • Claims payment
    • Claims accumulators
    • Benefit configuration
    • Provider
    • Contract configuration
    • Membership and enrollment
    • Authorization
    • Medical code edits
    • Program set-up
  • Coordinate with Applications Development Manager and Team Leads, in conjunction with the IT Project Manager, to ensure the priority of new work.
  • Work with external vendors to escalate support issues to completion, scope business functional enhancement projects and validate recommended solutions to the organization.
  • Complete other duties as assigned.

REQUIREMENTS

  • B.S. degree in Public Health or Computer Science preferred, but direct experience may be substituted.
  • Experience in working with HIPAA 5010 implementation guides and X12 ANSI EDI transactions. To include 837I, P, D; 834; 835; 278; 276 & 277; 270 & 271.
  • A minimum of three to five years of QNXT experience as an EDI Analyst, IT Analyst, or Lead Test Analyst.
  • Thorough understanding of all aspects of a claims processing system—including (but not limited to) EDI, claim adjudication, membership and enrollment, eligibility, configuration and benefits, authorizations and payment.
  • Excellent technical and analytical skills.
  • Good verbal and written communication skills. Ability to render and write business requirements such as technical documentation and business decision documentation.
  • Proficiency in requirements gathering—effectively translating business needs as expressed by users into workable specs, estimating time/duration to complete and implement the solution.

TECHINICAL SKILLS

  • Expert knowledge of the QNXT Claims Application and supported integration applications.
  • Microsoft SQL experience:
    • Use/write SQL queries to support technical design documents.
    • Use/ write SQL to support troubleshooting activities.
    • Use/write SQL queries to support testing/validation activities.

Apply Now

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.