EviCore by Evernorth · 15 hours ago
Claims Systems Configuration Senior Analyst - eviCore - Remote
United States
Full-time
Remote
Senior Level
$52K/yr - $86K/yr
5+ years exp
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Responsibilities
Provides direction and guidance to the team regarding policies, procedures, workflows, and claims service quality
Completes day-to-day Configuration tasks without immediate supervision but has ready access to advice from more experienced team members
Analyze complex business requirements to configure claim rules within the functionality of the system and responsible for monitoring claim service standards
Manage the accurate and timely additions of claims rules and administers disposition according to requirements and company policies and procedures
Communicates and educates regarding issues/trends to minimize errors
Resolves non-routine issues escalated from more junior team members
Qualification
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Required
High School Diploma or GED Required
5+ years of healthcare claims lifecycle; configuration design, editing, claims system requirements, and analysis Required
3+ years of ADVANCED experience in Microsoft ACCESS and EXCEL REQUIRED
3+ years of ADVANCED experience with SQL querying, database management systems REQUIRED
3+ years creating test plans/use cases, and SDLC models required
3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS)
Preferred
3+ years of experience with AS400, MC400, McNet and RC3 systems required
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
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
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