PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utahs public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance.

This job may be filled at any of the levels listed below.

Administrative Systems Analyst I- Min: $22.31/hr. Max: $27.89/hr

Administrative Systems Analyst II- Min: $26.52/hr. Max: $33.14/hr.

Administrative Systems Analyst III- Min: $66,028.04/yr. Max: $84,171.36/yr.

POSITION SUMMARY

PEHPs Administrative Systems Team plays a mission critical role in making PEHPs core administrative systems a competitive strength. The Administrative Systems Analyst I (Analyst) is responsible for assisting with the evaluation, testing, and implementation of required benefits and payment structure changes within the PEHP Administrative Systems. The Analyst must possess strong analytical skills, with the ability to perform complex business and product set up requirement analysis. Successful performance in this position will require a strong understanding of the benefits systems, the ability to analyze and problem solve simple to complex projects, and the ability to work semi-independently and within deadlines.

ESSENTIAL JOB FUNCTIONS AND DUTIES

1. System Configuration:
   1. Assists in the on-going evaluation of benefits configuration for new and existing benefit plans within HealthRules Payor, HealthRules Care Manager, and all associated interfaces and third-party systems.
   2. Analyzes explanation of benefits documents and master policies to ensure correct and efficient implementation.
   3. Assists in the setup of code sets and clinical guidelines used in benefits configuration and provider payments.
   4. Aids in the creation of test scripts, including regression testing cases, to validate system configuration against source documentation; tracks and tests new system functionality, enhancements, and bug fixes, including the development and execution of test plans.
   5. Assists with organizing the release of benefits configurations changes to production to reduce the potential for migration conflict.
   6. Ensures the quality and integrity of implementation of benefits change requests by assisting with production validation and audits.
   7. Maintains a strong understanding of the HealthRules Payor and HealthRules Care Manager systems features and capabilities, associated interfaces, and dependencies with other internal and third-party systems.
2. Process Optimization:
   1. Collects and analyzes data to assess and resolve operational obstacles to benefits design optimization.
   2. Assists with root-cause analysis on benefit set up issues and proposed set up changes.
   3. Applies Lean principles and methodologies to process and workflow designs.
   4. Identifies ways to enhance operational reports related to new business implementation processes.
   5. Helps track incoming requests and issue resolutions through productivity monitoring tools.
   6. Assists with the development of configuration standards and best practice guidelines, making recommendations where appropriate.
3. Documentation and Communication:
   1. Helps develop explanatory information for other departments to better understand administrative system configuration.
   2. Creates, designs, and implements training sessions, in person and virtual (instructor led and self-study), for all areas of the company with respect to their general and unique functions withing and in relation to the administrative systems and interfaces for internal and external system users.
   3. Develops and maintains Standard Operating Procedures (SOPs) and Desk Level Procedures (DLPs) manuals for all key processes associated with the administrative system for each area of PEHP.
   4. Responsible for timely release of new and updated SOPs and DLPs, providing training as necessary, reflecting any system upgrades and/or changes in configuration in general or for specific groups.
   5. Provides project and informational updates to management as available and/or assigned.
4. Maintains strict confidentiality in compliance with applicable federal and state law and PEHP policy.
5. Performs other duties as required.

Administrative Systems Analyst I Minimum Qualifications

Education and Experience

High School diploma and four (4) years of relevant managed care/health plan business analysis, or system software configuration experience, or an equivalent combination of education and experience is required.

Bachelor's degree with a strong emphasis in information technology, information systems, business, data analytics, or some other related field is strongly preferred.

Two (2) years of PEHP experience is preferred

Experience with HealthRules Payor and HealthRules Care Manager preferred.

Administrative Systems Analyst II Minimum Qualifications

Education and Experience

High School diploma and six (6) years of relevant managed care/health plan business analysis, or system software configuration experience, or an equivalent combination of education and experience is required.

Bachelor's degree with a strong emphasis in information technology, information systems, business, data analytics, or some other related field is strongly preferred.

Three (3) years of PEHP experience is preferred

Experience with HealthRules Payor and HealthRules Care Manager preferred.

Certified coder preferred.

Administrative Systems Analyst III Minimum Qualifications

Education and Experience

High School diploma and eight (8) years of relevant managed care/health plan business analysis, or system software configuration experience, or an equivalent combination of education and experience is required.

Bachelor's degree with a strong emphasis in information technology, information systems, business, data analytics, or some other related field is strongly preferred.

Four (4) years of PEHP experience is preferred

Experience with HealthRules Payor and HealthRules Care Manager preferred.

Certified coder preferred.

Knowledge, Skills, and Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position:

Required technical skills include the intermediate knowledge and ability of:

• Implementation processes within a claims operations or product management environment.
• Gathering, analyzing, and communicating complex requirements in a simple and easy to understand manner to both technical and non-technical staff.
• Familiarity with medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract concepts, and common claims processing/resolution practices.
• Project tracking, testing, and requirement tools (Microsoft Project, SharePoint, JIRA).
• Microsoft Excel.

Required working knowledge of:

• PEHP standards and contract compliance.

Must possess excellent communication skills:

• Communicate effectively with technical and non-technical members of various departments.
• Respond professionally to common inquiries or complaints.

Must have the ability to:

• Maintain a strong attention to detail.
• Follow written and verbal instructions.
• Prioritize work, multi-task, follow through with assignments, and perform within deadlines.
• Deal effectively with stress caused by workload and time deadlines.
• Work well in a team environment as well as independently.

The incumbent must always demonstrate judgment, high integrity, and personal values consistent with the values of URS.

Work Environment

Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing. Common eye, hand, finger dexterity required to perform essential functions.