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Claims Configuration Technical Analyst
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Job Description
- Req#: 35216
Role: Claims Configuration Technical Analyst
Duration: Long term
Remote
NOTE:
a. Claims experience - must have
b. EDI experience - must have
c. HRP experience (preferred, not a must-have)
Project Description:
About the Project - You will be part of a team dedicated to Claims Audit Gaine support for a non-profit Healthcare Organization in the US.
Our Team - You will collaborate with Product Owners, Managers, and Developers within the US and Mexico.
Responsibilities:
• Perform as a QA or BA to test Claims specifically for BlueCard business review and recommend modification to existing Claims Pricing configurations.
• experience in configuration within Health Rules (benefits and Package pricing) from development into the testing and deploying to the production environment.
• Recommends and implements benefit and pricing setup based on knowledge of system configuration capabilities and information obtained from business clients.
• Independently evaluates business procedures and problems.
• Hands-on working knowledge in resolving production issues related to Benefit configurations.
• Identifies research and resolves inaccuracies and inconsistencies in the business rules as they impact claims payment and other upstream and downstream transactions.
• Resolve post testing defects .
• Participates in business requirements gathering sessions to identify specifications and solutions.
• Evaluate and recommend configuration solutions to Business and IT leadership.
• Identifies and assesses potential problems and performs and implements system enhancements, modifications, and upgrades.
• Provides application and technical support for the Health Rules software as well as troubleshooting for end users.
• Works with IT to define business and IT systems requirements.
• Mentors and guides business users with the design and impact of configuration changes.
• Creates test case scenarios for application testing and ensures appropriate testing has been completed before the changes are deployed into the production environment.
• Designs, develops, and maintains user system documentation.
• Evaluates and monitor coded data elements.
• Assists users in understanding business system functions.
Mandatory Skills:
a. Claims experience
b. EDI experience
c. HRP experience (preferred, not a must-have)
• Strong client-facing experience with all levels of client leadership
• Deep understanding of Claims processing and workflows for multiple Lines of Business including FEP, and BCBS Association mandates (BlueCard).
• Strong experience in SQL and other relevant tools
Nice-to-Have Skills:
• HRP experience
• Experience in Agile methodology and framework.
• Working knowledge of MS Azure DevOps.About the company
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