- Work with business users to define and analyze problems and align the most appropriate technical, application or configuration solutions.
- Provide oversight of business requirement/specification maintenance via workflow system in accordance with customer deliverables.
- Solicit, develop, document and manage requirements and provide detailed design and business rules to support the requirements throughout project life cycle up to and through change control.
- Ensure that documentation is updated when change requests are approved for the project. Consider the business implications of the application of technology to the current and future business environment.
- Review system test plans and system tests modules before implementation.
- Work with the user to select or create appropriate scenarios to test all results to determine whether system changes met project specifications; use scenarios to assist the end user in acceptance testing.
- Conduct business process analyses, needs assessments, and preliminary cost/benefits analyses in an effort to align information technology solutions with business initiatives.
- Interprets business system configuration requests, and assigns to configuration staff in accordance with provider/employer contracts, and customer needs.
- Interacts with vendors and clients to determine innovative technical solutions to workflow implementation issues.
- Provides consultative services by actively participating on numerous cross-functional teams and projects, as well as troubleshooting inquiries and issues from multiple business owners.
- Resolves software and data issues and investigates accuracy of user transactions and their effects on the workflow system.
- Administers the data/configuration maintenance of system parameters, specifications, and data linkages to other systems involved in SOA component-based architecture.
- Researches complex problems to ascertain possible solutions.
- Design and implement solutions to support key business objectives, including developing design requirements and technical specifications.
- Develops, maintains, and disseminates internal and external system documentation, including status updates; prepares procedural and customer documentation when required.
- Provides technical guidance and influences the work of others involved in system configuration solutions.
- Consider the business implications of the application of technology to the current and future business environment
- 3 + years Healthcare insurer industry experience, with business knowledge of benefits, claim systems, and adjudication principles.
- 5+ years of advanced knowledge of system development methodology, project management, system architecture and business analytical/problem solving skills.
- Experience with medical claim business system software.
- Solid knowledge of medical and/or benefit policies, provider contract and/or employer plan designs, professional and facility claim processing, and medical terminology and industry standard code sets (CPT-4, ICD-9-CM, ICD-10, etc.)
- Knowledge of enrollment or claims EDI transactions and file formats (834, 837, 835, 270, 271), familiarity and experience with data mapping desired.
- Agile experience a plus.
- Must be able to manage multiple assignments, independently determine solutions, and anticipate/prevent potential problems.
- Strong analytical, organizational, interpersonal and communication skills.
- Proficiency in Microsoft Excel, and extensive use of data query logic.SQL experience is a plus.
- Project lead experience.