EviCore by Evernorth · 11 hours ago
Claims Systems Configuration Lead Analyst - eviCore - Remote
United States
Full-time
Remote
Mid, Senior Level
$61K/yr - $102K/yr
5+ years exp
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Responsibilities
Be the Subject Matter Expert for the eviCore claim systems, related job processes and provide SME support to Claims Systems Analysts and other internal departments, and external clients and vendors
Collaborate with associates, senior analysts, team leads and supervisors to identify solutions for procedural gap to support business needs
Support and lead client implementations and internal integration/migration efforts, and change requests, design documentation creation and/or approval
Resolves escalated systems issues from leadership, business, clients and junior team members
Analyze existing setups and system processes for opportunities to continually improve adjudication automation and accuracy, and update support documentation as necessary
Communicates concepts and insights to business leaders and partners in a relevant and actionable manner
Collaborate with technology and analytics teams to develop new data sources for reporting
Act as liaison between business and technology to execute project initiatives, and resolve issues - research and respond to questions in relation to process, requirements and testing
Responsible for new product and complex (multi-product and/or multi-state) eviCore claims systems client implementations and internal integration/migration efforts
Responsible for leading discussions with cross-functional teams, to understand, and evaluate processes, procedures (standard operating procedures, job aids, and work instructions)
Define business, technical and claim data exchange requirements, instruct on data file mapping (such as provider, member, auths, claims, etc.)
Design solutions for billing rule, benefits and provider configuration
Creating test/use cases, SI testing, and providing support for associated UA testing, as related to their SME role, to ensure proper interaction for current and future claims product use
Qualification
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Required
High School Diploma, required, bachelor’s degree preferred
3+ years of experience as a subject matter expert for claims system configuration, processing, reporting, issue triage and testing - REQUIRED
Project Management Experience - REQUIRED
Six Sigma Certification - REQUIRED
Experience in creation of test plans/use cases to support end to end testing - REQUIRED
Advanced experience with MS ACCESS - REQUIRED
Advanced experience with MS EXCEL - REQUIRED
Advanced experience with SQL and SQL querying - REQUIRED
Experience with all MS office products including PowerPoint - REQUIRED
5+ years of healthcare claims life cycle experience, emphasis in claims system requirements analysis and billing rule, benefits and provider configuration design - REQUIRED
Must be highly productive in a fast pace, dynamic organization and skilled in analyzing business and user requirements, and translating into proper system requirement specifications - REQUIRED
Excellent written, oral communication, client-based communication skills and interpersonal skills - REQUIRED
Preferred
Client facing communication and presentation skills
Knowledge of industry standard claims data types (837, 835, 277, 999) and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS)
Knowledge of database management systems (DB2, SQL Server)
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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