Key skills
SQLCommunication
About this role
Role Overview
- Play the role of Claims Domain lead for MMIS health care projects
- Drive the claims module and process
- Perform analysis of business requirements
- Design and develop documentation and ensure quality process
- Work in a team environment and provide guidance throughout the life cycle
- Meet customer expectations and troubleshoot problems in the application
- Assist customers in implementation decisions
Requirements
- Strong health care domain experience
- Good knowledge of Medicaid and Medicare
- Hands-on experience on claims processing and Adjudication processes
- Experience in Reference code/data sets required in Claims adjudication
- Understanding in configuring benefits or programs in claims system across various sub-systems
- Ability to run queries and perform basic system analysis
- Excellent written and spoken communication skills
- Ability to multitask between internal team and clients
- Close work with Dev, architecture and Design teams
- In depth understanding of Claims and Claims lifecycle
- Familiarity with systems like CMdS, GHS, Facets
- SQL skills to validate data in backend tables
- Validating X12 files and understanding data workflows
Tech Stack
- SQL
Benefits
- Health insurance coverage
- Voluntary dental and vision programs
- Life and disability insurance
- Retirement savings plan
- Paid holidays
- Paid time off (PTO) or vacation and/or sick time