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).