Workers Compensation - Medical Bill Review - Operations Analyst

Core Responsibilities:

• Serve as subject-matter expert for Medical Bill Review operations, providing advanced production support and driving process improvements.
• Coordinate cross-functional issue resolution and project execution, working with vendors and internal teams to ensure efficient bill processing.
• Maintain clear communication with Operating Units, providers, and stakeholders regarding issue status and required actions.

Operational Analysis:

• Monitor daily dashboards and vendor reports to identify adverse trends in bill turnaround time and track resolution progress.
• Recommend workflow enhancements and rule updates to improve accuracy, efficiency, and throughput in medical bill review.
• Document trends and resolutions to support auditability and foster continuous operational improvement.

Project Leadership & Collaboration:

• Lead business resources for regulatory audit responses, coordinating data gathering and documentation review prior to submission.
• Partner with Business Analysts on initiatives such as API implementations, vendor transitions, and payment process enhancements.
• Build strong relationships with internal teams, external vendors, clients, and medical providers to ensure professional standards.