Operations Analyst 2
at Public Consulting Group

Date Posted: 11/11/2019

Job Description

About Public Consulting Group

Public Consulting Group, Inc. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide. PCG’s Health practice offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes. To learn more, visit http://www.publicconsultinggroup.com/health/.


Duties & Responsibilities:

  • Configure claims system according to benefit plans and provider contracts and fee schedules
  • Validate member benefits against the benefit matrix
  • Update functional specifications according to change order from client
  • Analyzing and testing data on different billing and membership functionality manually and   writing queries on database for validating data
  • Responsible for interfacing with the Claims Department, client, and IT teams to identify business requirements, communicate and resolve claims issues, and project manage resolution tasks.
  • Update and maintain benefit and system configuration settings in our claims, billing, and data intermediary processing systems
  • Manage the system to complete the full production schedule for billing, processing, reporting and paying claims
  • Support multiple projects and teams by analyzing system performance, data quality, and performing root cause analysis on any issues related to our production systems. This includes claiming, eligibility, authorization and billing •        Provider management, including provider setup and updates in the system, as well as handling contract and fee schedule updates
  • Identify and report on inaccurate or missing data
  • Perform system testing, including creating test cases
  • Create and update training materials, and Policies and Procedures as necessary
  • Provide client and internal reports as requested.  
  • Create process flows, and participate in process improvement projects
  • Work within a team to complete special projects, or perform other duties as necessary to meet client deadlines


Required Skills:

  • Experience with Plan Building required
  • Experience with Cognizant/Trizetto QicLink or other Claims System Platform Required
  • Excellent verbal and written communication skillsAbility to manage and coordinate several ongoing assignments while meeting deadlines and performance goals
  • Strong analytical skills
  • Ability to work independently or with a team
  • Attention to detail
  • Experience with Microsoft Office applications, specifically Excel, Word and Access
  • Experience with SQL Management Studio

Education/Experience: Bachelor’s degree or 4 years of relevant healthcare experience preferred


Job Snapshot

About Us

Public Consulting Group, Inc. (PCG) provides management consulting and technology services to help public sector education, health, human services, and other government clients achieve their performance goals and better serve populations in need. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has more than 1,700 professionals in 55 offices around the U.S. and in Montreal, UK and Poland. The firm draws on more than two decades of consulting to public sector clients in all 50 states and Canada to deliver best-practice solutions and measurable results to state and local public agencies, state-operated facilities, and private providers that do business with government agencies.

PCG is committed to a diverse workforce which is a reflection of our clients and the people they serve. Our organizational culture attracts and rewards people who are results-oriented and interested in making an immediate impact on their community as well as their own career.

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