| 5+ yrs Risk Assessment Analyst :: No CPT at Remote, Remote, USA |
| Email: [email protected] |
| From: Anamika, RCI [email protected] Reply to: [email protected] Role: Risk Assessment Analyst Location: 100% Remote Duration: 6+ months Visa - No CPT Healthcare experience and Linked is a MUST Description : As a Risk Assessment Analyst at Delta Dental, you will play a crucial role in ensuring the integrity and reliability of our health insurance payor operations. A comprehensive knowledge of the risk management life cycle (from identification through to reporting) is paramount to being successful in this role. You will be responsible for understanding the end-to-end risk assessment process, evaluating the efficacy of controls, and collaborating across all business functions to provide guidance that helps to mitigate risks effectively. Qualifications : Bachelor's degree in Business, Risk Management. Finance, or a related field. Master's degree or relevant certifications (e.g., CRM. ARM, CISA) is a plus. Proven experience in risk assessment (4+ years in risk management) within the health insurance payor industry, with a deep understanding of the insurance value chain. , General knowledge of risk control self-assessment processes. Strong knowledge of risk rating/scoring methodologies, ethical standards, and controls in health insurance payor operations. Excellent analytical and problem-solving skills, with the ability to use data to drive decision-making. Experience using Microsoft Office suite of products (excel, power-point, word) and Governance, Risk & Compliance (GRC) workflow platforms. Effective communication skills, including the ability to convey complex information to various stakeholders. Collaborative mindset and the ability to work across diverse business functions. Knowledge of relevant industry regulations and compliance requirements. , Proficiency in using risk assessment and data analysis too Responsibilities : End-to-End Risk Assessment : Conduct comprehensive identification and assessment of risks within Delta Dentals legislation/regulation and regulatory/group client exam findings portfolios; from policy/contract creation to claims processing/settlement. Identify potential vulnerabilities and areas of improvement. Ethics and Controls Evaluation : Analyze and evaluate the effectiveness of controls in place to mitigate risks, ensuring compliance with industry regulations and ethical standards. Cross-Functional Collaboration : Work closely with various business functions, including actuarial, underwriting, claims, legal, compliance, grievance & appeals, credentialing, provider network, and finance, to understand their processes and assess risk exposure. Collaborate on risk mitigation strategies. Risk Mitigation Planning : Design and recommend risk mitigation plans and strategies based on assessment findings, working with relevant stakeholders to ensure proactive risk management. Data Analysis : Utilize data analysis tools and methodologies to identify trends and patterns that may indicate potential risks or areas for improvement in our health insurance payor processes. Documentation and Reporting : Maintain accurate and detailed records of risk assessment activities. Prepare and present reports to senior management and stakeholders on a regular basis. Compliance Monitoring : Monitor changes in health insurance payor regulations and industry standards to ensure ongoing compliance and recommend necessary adjustment . Keywords: |
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| Fri Oct 06 02:47:00 UTC 2023 |