Join the APWU Health Plan team

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.

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EOE M/F/D/V; Drug-Free Employer

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.

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EOE M/F/D/V; Drug-Free Employer