MagnaCare is seeking experienced Network Data Analysts to analyze healthcare providers for specified clients/products, ensuring the integrity and accuracy of data, performing root cause analysis, reporting results, and re-processing claims.
Primary Responsibilities
Maintain integrity of provider data including network affiliations, out-of-area network partners, provider demographics, and updating fee schedule assignment for participating facilities.
Work with the interdepartmental stakeholders to resolve issues with contracted groups and facilitate database implementation.
Liaise between IT and client on all network roster-related inquiries.
Use sound judgment to resolve electronic claim submission, review incoming claim files, pinpoint electronic formatting errors, perform root cause analysis, and report findings.
Identify provider issues at network and product levels; develop methods to prevent the issues from recurring and recommend corrective action.
Work with other analysts to develop improvements, modifications, and enhancements in claims resolution.
Review and create audit reports to perform quality analysis on existing data and process corrections.
Research and document pertinent information on claims requiring adjudication.
Apply medical policy, contractual provisions, and operational procedures to ensure accurate adjudication and/or adjustment.
Coordinate with claims team to escalate claim adjustments.
Adhere to HIPAA guidelines and regulations through daily job functions.
Essential Qualifications
Bachelor's degree or equivalent work experience, preferably in healthcare.
Diverse analytical and interpersonal skills.
Ability to maintain a professional demeanor through written and verbal correspondence.
Organizational skills, with a proven ability to work independently and in team settings.
Familiarity with healthcare provider data, including fee schedules, contracts, and electronic claims submissions.
Excellent problem-solving skills related to automated systems and operations.
Proficiency in Microsoft Office (Word and Excel).
At MagnaCare LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect, and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
For more than 30 years, MagnaCare LLC has been a trusted partner in delivering flexible, customized solutions for self-insured organizations. As a national third-party administrator (TPA), we combine proprietary technology, network expertise, and a deep understanding of labor to help our clients achieve their goals while supporting the people they serve.
Our focus on labor means we work closely with funds, Taft-Hartley Trusts, and other self-insured groups to deliver tailored solutions that go beyond the basics. From health plan administration and eligibility management to contribution accounting, we provide the tools and support organizations need to succeed. With specialized offerings such as flexible network administration, direct contracting, in-house medical and care management, and workers’ compensation programs, we create benefit plans that address unique needs with precision.
