Operations Configuration and Integration Analyst

This is a fully remote position, open to applicants in New York.

📋 Description

• Develop, modify, test, and maintain system configuration tables and files to ensure precise claims adjudication.

• Analyze, interpret, load, test, and manage configurable tables, files, and software related to claim adjudication.

• Assist in the creation and execution of testing scenarios and conditions.

• Conduct unit and/or end-user testing for new configurations, programming enhancements, benefit designs, provider contracts, and software modifications.

• Identify potential opportunities and suggest system solutions to enhance automation, address system shortcomings, and improve claims processing.

• Observe company business strategies and market trends to support future organizational needs.

• Investigate and resolve issues or problems related to configuration and claims.

• Create system queries to assess the scope of issues and propose recommendations to management.

• Act as a technical resource for translating system specifications and operational guidelines.

• Coordinate system programming modifications and timelines with IS Business Analysts and Programmers.

• Maintain an extensive understanding of claims adjudication rules, MC400 editing, claim processing software, Macess imaging, and related applications.

• Execute other assigned responsibilities.

⛳️ Requirements

• Must have authorization to work in the U.S. without requiring employment-based visa sponsorship now or in the future.

• Bachelor’s Degree or an equivalent combination of education and experience in a managed care setting.

• At least two to three years of experience in an automated medical claims environment and managed care/multiple product settings is preferred.

• A minimum of one to two years of experience in systems logic and testing is preferred.

• Familiarity with claims adjudication rules, MC400 editing, claim processing software, Macess imaging system, and related software applications.

• Understanding of configurable tables, files, and software that support claims adjudication.

• Experience in developing testing scenarios, test conditions, unit testing, and/or end-user testing.

• Experience in developing system queries.

• Must adhere to all policies and standards.

🏝️ Benefits

• Health insurance

• 401K plan

• Stock purchase plan

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements including remote, hybrid, field, or office schedules

• Additional forms of incentives may be included in total compensation