- 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 HealthRules (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 HealthRules 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.
Skills:
- Claims experience - Must have
- EDI experience - Must Have
- 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 client Association mandates (Bluecard).
- Strong experience in SQL and other relevant tools