-Research and provide business solutions to complex organizational initiatives and should demonstrate an extensive expertise in the claim's platform and all interfacing applications, both customized and packaged.
-Demonstrate understanding in the business requirements that support reimbursement policies and methodologies of the organization, as well as perform complex data analysis and draw business conclusions for decision making.
-Coordinate the maintenance of assigned Claims Department systems for the program and play a key role in the configuration and implementation of new markets and products
-Recommend solutions based off of root cause findings.
-Responsibilities include but are not limited to claim analysis, root cause analysis, interpretation of configuration requirements, ad- hoc reporting and documentation.
-3+ years of experience with SQL data analysis (ability to pull data and write SQL Queries)
-Bachelor's level degree
-Claims Adjudication Life Cycle experience
-Claims Root-Cause support experience
-Knowledge & understanding of Member Enrollment, Provider Contracts, Benefits and Authorization and Claims workflow
-Experience supporting QNXT or a similar claims platform (FACETS, etc.)
-Health Care Government Program experience.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.