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Evolent Health Analyst, Claims Audit in Boston, Massachusetts

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

The Operational Quality Audit Analyst is a key member of the Operational Quality Audit (OQA) team supporting problem resolution, data analyses, process improvements, and more. This person will work closely with the Director of Operational Quality Audit and other key leaders across functional areas within Evolent to ensure integrity of the data, systems, and processes specific to our audit activities. This position requires attention to detail, ability to work in a team environment, strong multi-tasking skills, advanced analytical thinking ability, along with strong computer skills.

Essential Functions:

  • Detailed analysis around existing processes across OQA functional areas and others to identify risks, gaps, and necessary updates.

  • Coordinate and engage in root cause analysis, remediation, and analytical problem solving on complex, multi-functional issues.

  • Develop, generate, and review numeric/anecdotal data including claims financial data, synthesize findings for key stakeholders.

  • Support monthly Service Level Agreement reporting details for SLAs applicable to OQA.

  • Conduct research, investigate workflows, business procedures, and recommend changes.

  • Run claims reports and provide detailed analysis, including denial reports, paid reports, provider specific reports, and detailed investigations on pending claims

  • Create and manage productivity reports.

  • Perform ad-hoc analysis for OQA team as requested.

  • Other duties as assigned.

The Experience You’ll Need (Required):

  • 1-3 years of professional experience in an operations or analytics role at a health plan/payer/insurer or hospital system

  • Must be analytical, detail oriented, and possess desire to advance and grow personally and professionally

  • Ability to effectively communicate both orally and written, in clear and concise manner with clients and non-technical team members

  • Ability to build consensus and relationships among all levels of the organization

  • Demonstrates strong analytical, organizational, and critical thinking skills

  • Demonstrates skills in multi-tasking and prioritizing information and projects, often with varying timelines

  • Excellent computer skills, specifically with Excel, PowerPoint, Word

  • Ability to work independently

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Compensation Range:

The typical range of employees within the compensation grade of this position is . Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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