Skin Care Claims Analyst
Alta Resources is Hiring!The Claims Analyst reviews all medical and legal claims sent by consumers.
This position reviews all documentation in detail and determines if any of it contains medically/legally relevant information that needs to be sent to the Medical Safety Partners, by business unit (Office of Consumer Medical Safety (OCMS), Global Medical Safety (GMS), Local Safety Office (LSO)), Medical Information, Nutritionals Product Safety or client Law Department.
Based on the documents received, the Claims Analyst makes a decision on whether to approve the claim, deny the claim, or if any documentation needed is still missing.
Throughout this process, this position works with a variety of departments within Kenvue and is typically the final communicator back to the consumer.
Essential Duties & ResponsibilityOther duties may be assigned.
Full documentation review on all medical and legal claims documentation from consumers or departments According to the nature of the documents, determine if they contain medically/legally relevant information that needs to be sent to OCMS, GMS, LSO, Medical Information or Law Department, and if so, send those documents to the appropriate department in a secure way (in 24 hours) Continuously update the CRS, appropriate departments and/or the consumer as updates in the claims process arise Data entry on all medical and legal documentation into the CRS system Maintain confidentiality throughout all responsibilities and ensure compliance with client privacy policies Medical Claims Receive medical claims from consumer and/or the client and review for requests regarding reimbursement Determine if additional information is needed for the medical claim and review all documents in order to make a decision on whether to approve or deny the claim Legal Claims Receive legal claims from the client that have been sent over by the court Verify the type of legal claim, the stage of the lawsuit, and who the consumer and lawyer is and verify the medical information contained in the legal claim Gather the information on the client product that are involved and the type of adverse event that has occurred in the legal claim documents and report findings back to the client Adhere to applicable Program, Client and Corporate policies, procedures and work instructions.
Manage Consumer/Health Care Professional/Regulatory contacts relating to US and/or Canadian drug, medical device, cosmetic and/or dietary supplement products and/or their proper use, contraindications, adverse events/complaints, formulation, distribution and/or recall.
Accurately assess issues and, based on analysis, assign adverse event/product quality pharmacovigilance subject code(s) to conform to Client, U.
S.
Food and Drug Administration (FDA), Health Canada and MedWatch pharmacovigilance reporting standards and regulations.
Apply good documentation principles conforming to U.
S.
FDA's 21 CFR 210, 211 Current Good Manufacturing Practice for Finished Pharmaceuticals (cGMP) and 21 CFR 820 Quality System Regulation to clearly and accurately record contact/product data, contact verbatim, medical information, pharmacovigilance subject codes, and dates/reasons for any changes in proper database/paper locations to support Client reporting to regulatory authorities.
Escalate critical issues to designated management representatives.
Handle and protect individually-identifiable health information in accordance with HIPAA and similar security/privacy regulations and standards.
Support duties for Quality/Oversight/Audit as follows:
Respond to questions from auditors/government inspectors in professional, factual manner.
Provide assistance for audit preparation and/or audit/inspection support as may be requested by management.
Manage work with a view to continuous quality improvement.
Promptly notify Team Leader or subject matter expert with any questions about how or if a task should be performed.
Immediately notify supervisor and Quality/Compliance team about any potential nonconformance.
Event Support (e.
g.
, Product Recall, major media news) Schedules:
Quickly adjust schedules and work extended hours necessary to support event.
Training:
Complete training and understand new information related to the event subject in short period of time.
Regular attendance, punctuality and adherence to agreed-upon schedule of availability are conditions of employment and essential function of this position.
Leadership ResponsibilitiesAlthough this position will not have responsibility for direct reports, the position requires active leadership in the way of supporting strategic initiatives as well as active personal development and application of the Six Sigma methodologies.
QualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Displays a high level of confidence, enthusiasm and a positive attitude with the desire to succeed and exceed customer expectations.
Has a passion to serve others.
Demonstrated written communicator.
Excellent interpersonal, verbal and written communication skills.
Ability to establish rapport, builds relationships and loyalty with external and internal customers and coworkers, and remains tactful when communicating negative information.
Demonstrate an ability to display patience, empathy, and strong listening skills while ensuring customer needs are fulfilled in a timely and satisfactory fashion.
Demonstrate an ability to maintain composure while diffusing and professionally negotiating a high-tension situation on a routine basis.
Strong retention skills with the ability to follow a process flow and/or script as needed.
Highly self-motivated with the ability to prioritize complex, diversified responsibilities, multi task effectively and execute tasks with minimum supervision.
Strong organization and time management skills.
Ability to remain focused and productive with tasks that may be repetitive.
Strong attention to detail and accuracy.
Solid logical decision making and troubleshooting skills with the ability to problem solve in a timely and effective manner.
Exercises good judgment.
Takes ownership of issues or questions and will escalate problems to the appropriate person and follow up accordingly to the customer.
Knows when to involve supervisors.
Ability to maintain a high level of confidentiality by handling sensitive and private client and customer information in accordance to Alta Resources and Client's policies and regulatory requirements.
Understands and appreciates the risks and consequences of inappropriate communication in a virtual environmentEmbraces change and is flexible to the needs of the business and team.
Proven ability to meet deadlines and key metrics, work independently, as a team player, and drive results in a fast paced, team based environment.
Must be willing to assist teammates and build strong relationships to achieve company and department goals.
Ability to accept and apply coaching and feedback from leadership.
Proven track record of reliability and a strong work ethic is a must.
Complete all required training by deadlines.
Demonstrate applied competency in quality/compliance standards and applicable Program, Client and Corporate policies, procedures and work instructions though appropriate and timely analysis, decision-making, communication and recordkeeping.
Successfully complete all Certification program(s) that apply to assigned role(s).
EDUCATION and/or EXPERIENCEA Bachelor's degree from a four-year college or university is required; a nursing or law degree is preferred.
3-5 years' experience within a medical or legal claims position is required.
TECHNOLOGY SKILL BASE This position requires a working knowledge of computer technology that includes:
Beginning MS Word and Excel.
Individuals must possess the ability to learn and understand new software and other technology applications as introduced by the Client and Alta Resources.
LANGUAGE SKILLS Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
MATHEMATICAL SKILLSAbility to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply concepts of basic algebra and geometry.
REASONING ABILITY Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Work EnvironmentThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The environment for which this position functions contains scents and fragrances related to product samples that are necessary to have on-site in order to complete the essential job functions of this position or others positions within the same area.
Due to the nature of this work individuals are required to be on-site during hours designated by the Client, however, the occasion will arise when the employee must be off-site due to business functions.
Neenah, WI Brea, CA Fort Myers, FL Pasig City, PH Belize City, BZ Mexico City, MXAbout Us Careers Need Assistance 877.
464.
2582 Privacy PolicyOther details Job Family Ops/Corporate Support Pay Type Salary Apply Now Recommended Skills Active Listening Attention To Detail Business Correspondence Calculations Claim Processing Confidentiality Estimated Salary: $20 to $28 per hour based on qualifications.
This position reviews all documentation in detail and determines if any of it contains medically/legally relevant information that needs to be sent to the Medical Safety Partners, by business unit (Office of Consumer Medical Safety (OCMS), Global Medical Safety (GMS), Local Safety Office (LSO)), Medical Information, Nutritionals Product Safety or client Law Department.
Based on the documents received, the Claims Analyst makes a decision on whether to approve the claim, deny the claim, or if any documentation needed is still missing.
Throughout this process, this position works with a variety of departments within Kenvue and is typically the final communicator back to the consumer.
Essential Duties & ResponsibilityOther duties may be assigned.
Full documentation review on all medical and legal claims documentation from consumers or departments According to the nature of the documents, determine if they contain medically/legally relevant information that needs to be sent to OCMS, GMS, LSO, Medical Information or Law Department, and if so, send those documents to the appropriate department in a secure way (in 24 hours) Continuously update the CRS, appropriate departments and/or the consumer as updates in the claims process arise Data entry on all medical and legal documentation into the CRS system Maintain confidentiality throughout all responsibilities and ensure compliance with client privacy policies Medical Claims Receive medical claims from consumer and/or the client and review for requests regarding reimbursement Determine if additional information is needed for the medical claim and review all documents in order to make a decision on whether to approve or deny the claim Legal Claims Receive legal claims from the client that have been sent over by the court Verify the type of legal claim, the stage of the lawsuit, and who the consumer and lawyer is and verify the medical information contained in the legal claim Gather the information on the client product that are involved and the type of adverse event that has occurred in the legal claim documents and report findings back to the client Adhere to applicable Program, Client and Corporate policies, procedures and work instructions.
Manage Consumer/Health Care Professional/Regulatory contacts relating to US and/or Canadian drug, medical device, cosmetic and/or dietary supplement products and/or their proper use, contraindications, adverse events/complaints, formulation, distribution and/or recall.
Accurately assess issues and, based on analysis, assign adverse event/product quality pharmacovigilance subject code(s) to conform to Client, U.
S.
Food and Drug Administration (FDA), Health Canada and MedWatch pharmacovigilance reporting standards and regulations.
Apply good documentation principles conforming to U.
S.
FDA's 21 CFR 210, 211 Current Good Manufacturing Practice for Finished Pharmaceuticals (cGMP) and 21 CFR 820 Quality System Regulation to clearly and accurately record contact/product data, contact verbatim, medical information, pharmacovigilance subject codes, and dates/reasons for any changes in proper database/paper locations to support Client reporting to regulatory authorities.
Escalate critical issues to designated management representatives.
Handle and protect individually-identifiable health information in accordance with HIPAA and similar security/privacy regulations and standards.
Support duties for Quality/Oversight/Audit as follows:
Respond to questions from auditors/government inspectors in professional, factual manner.
Provide assistance for audit preparation and/or audit/inspection support as may be requested by management.
Manage work with a view to continuous quality improvement.
Promptly notify Team Leader or subject matter expert with any questions about how or if a task should be performed.
Immediately notify supervisor and Quality/Compliance team about any potential nonconformance.
Event Support (e.
g.
, Product Recall, major media news) Schedules:
Quickly adjust schedules and work extended hours necessary to support event.
Training:
Complete training and understand new information related to the event subject in short period of time.
Regular attendance, punctuality and adherence to agreed-upon schedule of availability are conditions of employment and essential function of this position.
Leadership ResponsibilitiesAlthough this position will not have responsibility for direct reports, the position requires active leadership in the way of supporting strategic initiatives as well as active personal development and application of the Six Sigma methodologies.
QualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Displays a high level of confidence, enthusiasm and a positive attitude with the desire to succeed and exceed customer expectations.
Has a passion to serve others.
Demonstrated written communicator.
Excellent interpersonal, verbal and written communication skills.
Ability to establish rapport, builds relationships and loyalty with external and internal customers and coworkers, and remains tactful when communicating negative information.
Demonstrate an ability to display patience, empathy, and strong listening skills while ensuring customer needs are fulfilled in a timely and satisfactory fashion.
Demonstrate an ability to maintain composure while diffusing and professionally negotiating a high-tension situation on a routine basis.
Strong retention skills with the ability to follow a process flow and/or script as needed.
Highly self-motivated with the ability to prioritize complex, diversified responsibilities, multi task effectively and execute tasks with minimum supervision.
Strong organization and time management skills.
Ability to remain focused and productive with tasks that may be repetitive.
Strong attention to detail and accuracy.
Solid logical decision making and troubleshooting skills with the ability to problem solve in a timely and effective manner.
Exercises good judgment.
Takes ownership of issues or questions and will escalate problems to the appropriate person and follow up accordingly to the customer.
Knows when to involve supervisors.
Ability to maintain a high level of confidentiality by handling sensitive and private client and customer information in accordance to Alta Resources and Client's policies and regulatory requirements.
Understands and appreciates the risks and consequences of inappropriate communication in a virtual environmentEmbraces change and is flexible to the needs of the business and team.
Proven ability to meet deadlines and key metrics, work independently, as a team player, and drive results in a fast paced, team based environment.
Must be willing to assist teammates and build strong relationships to achieve company and department goals.
Ability to accept and apply coaching and feedback from leadership.
Proven track record of reliability and a strong work ethic is a must.
Complete all required training by deadlines.
Demonstrate applied competency in quality/compliance standards and applicable Program, Client and Corporate policies, procedures and work instructions though appropriate and timely analysis, decision-making, communication and recordkeeping.
Successfully complete all Certification program(s) that apply to assigned role(s).
EDUCATION and/or EXPERIENCEA Bachelor's degree from a four-year college or university is required; a nursing or law degree is preferred.
3-5 years' experience within a medical or legal claims position is required.
TECHNOLOGY SKILL BASE This position requires a working knowledge of computer technology that includes:
Beginning MS Word and Excel.
Individuals must possess the ability to learn and understand new software and other technology applications as introduced by the Client and Alta Resources.
LANGUAGE SKILLS Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
MATHEMATICAL SKILLSAbility to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply concepts of basic algebra and geometry.
REASONING ABILITY Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Work EnvironmentThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The environment for which this position functions contains scents and fragrances related to product samples that are necessary to have on-site in order to complete the essential job functions of this position or others positions within the same area.
Due to the nature of this work individuals are required to be on-site during hours designated by the Client, however, the occasion will arise when the employee must be off-site due to business functions.
Neenah, WI Brea, CA Fort Myers, FL Pasig City, PH Belize City, BZ Mexico City, MXAbout Us Careers Need Assistance 877.
464.
2582 Privacy PolicyOther details Job Family Ops/Corporate Support Pay Type Salary Apply Now Recommended Skills Active Listening Attention To Detail Business Correspondence Calculations Claim Processing Confidentiality Estimated Salary: $20 to $28 per hour based on qualifications.
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