The Policy Testing Analyst role is responsible for testing Medical Policies to ensure product integrity, accuracy and quality. This role serves as a checkpoint by running test scenarios to ensure the medical policies invoke appropriately and are in line with each client’s policy. 

This area of our business allows a lot of opportunity for advancement and the Medical Policy team will be considering candidates that are looking to start their career in the corporate healthcare space and is a recent college graduate OR candidates that have been working in healthcare claims, medical policy, or other similar experience.

Key Responsibilities (after training)

• Develops test scenarios to thoroughly test medical policies (Temp Rules, Switch Requests, and Change Requests).
• Analyzes and troubleshoots erroneous results, determines the root cause and suggests a solution.
• Communicates effectively and timely with upstream functional areas to resolve issues.
• Maintains minimal error rate of less than 3 (Critical Omissions) per quarter.
• Conducts Regression Testing of medical polices to ensure client specific medical policy accuracy and quality.
• Evaluates Pre/Post test results of client files for accuracy and quality.
• Meets daily and monthly production and quality targets.
• Assists with Research Requests.
• Participates in other projects, as needed.
• Other duties as assigned.

Education Requirements

• Bachelor's Degree or equivalent work experience preferred. 
• High school diploma required. 

Preferred Experience: 

• Health plan operations experience working with medical policies, edits, or claims. 

Skills, Experience or Other Requirements

• Ability to learn and quickly apply new material.
• Ability to adapt to changing situations with ease.
• Ability to think "outside the box".
• Ability to work collaboratively to achieve results.
• Self-starter, with strong confidence level.
• Strong analytical and problem-solving skills.
• Experience in Microsoft Office (Excel, Word, PowerPoint), 2 years' minimum.
• Professional with the ability to properly handle confidential information.
• Ability to work well independently and in a team environment.
• Ability to handle multiple tasks, prioritize and meet deadlines.
• Excellent written and verbal communication skills.
• Time management skills and have the ability to understand that much or the work we do is time sensitive.
• Ability to adjust schedule to meet release deadlines, as needed (evenings / weekends).
• Must have ability to positively handle / manage stress, such as high work volume and frequent change.
• Must have flexibility and willingness to participate in the work processes or an international organization, including conference calls scheduled to accommodate global time zones.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Base compensation ranges from $22.50 to $27.50. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. 

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 9/20/2024

Applications are assessed on a rolling basis. We anticipate that the application window will close on 11/20/2024, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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