EviCore by Evernorth · 3 days ago
Claims Systems Configuration Quality Review Senior Analyst - eviCore - Remote
United States
Full-time
Remote
Senior Level
$51K/yr - $85K/yr
5+ years exp
Maximize your interview chancesHealth CareHospital
Insider Connection @EviCore by Evernorth
Get 3x more responses when you reach out via email instead of LinkedIn.
Responsibilities
Resolve non-routine issues escalated from leadership, business, clients and junior team members and act as a subject matter expert (SME) to business and IT for eviCore claims product setups/processes
Collaborate with internal and external clients to understand, and evaluate processes, procedures, job aids and identify solutions for procedural gaps
Analyze business and user requirements to design solutions and system configurations, specifications, create test plans/use cases perform SI testing, end to end testing and continuously improve adjudication automation and accuracy.
Partner with technology and analytics teams to develop new data sources for reporting and act as liaison between business and technology to execute project initiatives, and resolve issues
Qualification
Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.
Required
High School Diploma or GED required
Strong analytical skills
The ability to work independently and as a team
Strong communication skills
5+ years of healthcare claims lifecycle; configuration design, editing, claims system requirements, and analysis required
3+ years of experience in Microsoft ACCESS and EXCEL required
3+ years of experience with SQL querying, database management systems, creating test plans/use cases, and SDLC models required
3+ years of experience with AS400, MC400, McNet and RC3 systems required
3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS)
Benefits
Medical
Vision
Dental
Well-being and behavioral health programs
401(k) with company match
Company paid life insurance
Tuition reimbursement
A minimum of 18 days of paid time off per year
Paid holidays
Company
EviCore by Evernorth
EviCore by Evernorth (EviCore) offers proven, diversified medical benefits management solutions that help clients reduce costs while increasing quality of care for their members.
5,001-10,000 employees
H1B Sponsorship
EviCore by Evernorth has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2020 (33)
Funding
Current Stage
Late StageTotal Funding
$300MKey Investors
TA Associates
2017-10-10Acquired· undefined
2014-01-10Private Equity· undefined
2010-11-10Private Equity· $300M
Leadership Team
Stephen Mengert
CFO
Sean D' Souza
Medical Director & Vascular Surgery
Recent News
Company data provided by crunchbase
