Claims Systems Lead Analyst - EviCore - Remote

· Creating test plans/use cases, and SDLC models.

About Evernorth Health Services

Qualifications

• · 5+ years of claims and health care experience required
• · Experience running complex queries utilizing Microsoft SQL
• · Proficient in Microsoft Access Database (including queries and data manipulation) is required
• · Proficient in Microsoft Excel (including pivot tables, charts and formulas) is required
• · Strong technical competence, proven critical thinking, and impeccable communication skills are required
• · Accomplished in claims lifecycle knowledge and claims adjudication framework
• · Industry standard claims data types and editing rules (ICD, CPT/HCPC, Rev Codes, NCCI).
• · Familiarity with database management systems (DB2, SQL Server)
• · Creating test plans/use cases, and SDLC models.
• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Preferred Qualifications

• · Bachelor Degree in a computer related field preferred or equivalent work experience
• · 5+ years of experience in medical Claims Systems Configuration preferred
• · External client facing experience preferred

Responsibilities

• · Works independently and complete tasks with minimal supervision
• · Work from Azure Dev ops utilizing project methodologies to maintain and upkeep tickets for Claim System projects and requests
• · The Lead analyst will mentor the Sr. Analyst on complex enhancement and configuration designs
• · Provide support as a Claim Systems subject matter expert to internal departments such as but not limited to Claims Configuration, Client Engagement, Program leads, Claims IT Development team
• · Lead external client calls to support clients in all aspects of the Claim System application
• · Define business, technical, and claim data exchange requirements.
• · Instruct on data file mapping (such as provider, member, authorizations, claims, etc.)
• · Create test/use cases, perform SI testing, and provide support for associated UA testing in order to successfully complete EviCore claims systems client implementations, internal integration/migration efforts.
• · Create simple to complex SQL queries to review Claim system configuration and claims data
• · Make updates to configuration via Access Database
• · Run Postproduction review on claims to validate changes deployed to production are processing as expected
• · Investigate claim processing to determine Claim Configuration root cause analysis
• · The associate will be responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments to support these requirements.
• · Additional responsibilities may include assisting the reporting development team, RFP data processing requests, training, maintenance transition and process/product workflow/documentation.
• · This associate will perform duties under self-direction and is expected to make decisions as necessary.