Position Summary

The Litigation Project Analyst, Sr provides expertise data support to projects related to confidential client information in claims litigation in accordance with company policy, regulatory requirements, and client needs.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
Key Duties and Responsibilities

• Acts as lead project resource to stakeholders including attorneys, client, management, and auditors.
• Manages routine and complex audits of claims to ensure payment integrity in accordance with regulatory standards, plan benefit guidelines, and company policy.
• Reviews system processing of claims to ensure coding and system configuration are aligned with contract specifications. Identifies noncompliant processes or outcomes and determines appropriate steps for resolution.
• Completes and maintains detailed claim documentation for all assigned projects to include decision methodology, system or processing errors, and monetary discrepancies. Prepares reports of information for presentation to client and attorneys.

• Partners with management, Legal, and client to interpret plan, ACS, CMS, and other regulatory guidelines. Creates, implements, and monitors processes in accordance with appropriate regulatory guidelines.
• Provides insight at case team meetings to ensure project participants are informed and aware of the objectives and requirements of a project.
• Recognizes and resolves technical issues identified during special project work and assigns resolution to appropriate staff.
• Interprets discovery data specifications and provides feasibility feedback to team and makes recommendations to management for changes or improvements to be implemented.
• Performs other related duties as assigned.

Minimum Qualifications

• High school diploma or GED.
• Four years of experience working on the Special Projects Team.
• Demonstrated proficiency of plan guidelines and claims adjudication process.
• Proficiency with MS Office tools and applications.

Preferred Qualifications

• College degree in Mathematics, Statistics, or similar discipline.
• Certifications in SQL, R, VBA, or Python.

*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before.

We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American!

We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!