Claims Systems Lead Analyst - EviCore - Remote

Role summary

Systems delivery and collaboration

• Manage complex claims-systems projects and implementations.
• Maintain project tickets and requests in Azure DevOps.
• Mentor senior analysts on complex enhancement and configuration designs.
• Provide subject matter expertise to internal configuration, client engagement, program, IT development, and QA teams.
• Lead client calls and support clients using the claims-system application.
• Define business, technical, and claims data-exchange requirements and instruct on data-file mapping.

Testing and configuration

• Create test cases, perform system integration testing, and support user acceptance testing for implementations and integration or migration work.
• Write SQL queries to review configuration and claims data and update configuration using Microsoft Access.
• Review post-production claims to validate deployed changes and investigate processing issues to determine root causes.
• Other possible work includes reporting support, RFP data requests, training, maintenance transitions, and workflow or product documentation.

Required qualifications

• Five years of claims and healthcare experience.
• Experience running complex queries using Microsoft SQL.
• Proficiency in Microsoft Access queries and data manipulation and in Microsoft Excel pivot tables, charts, and formulas.
• Strong technical competence, critical thinking, and communication skills.
• Knowledge of claims lifecycle, claims adjudication frameworks, and standard claims data types and editing rules, including ICD, CPT/HCPC, Rev Codes, and NCCI.
• Experience creating test plans or use cases and knowledge of SDLC models.

Preferred qualifications

• Five years of medical claims systems configuration experience is preferred.
• A bachelor’s degree in a computer-related field or equivalent work experience is preferred.
• External client-facing experience is preferred.
• Familiarity with database management systems such as DB2 or SQL Server.

Remote work conditions

• The title identifies the role as remote.
• For employees working from home occasionally or permanently, the internet connection must be cable broadband or fiber with at least 10 Mbps download and 5 Mbps upload.