Senior Technical Specialist – Healthcare

This is a fully remote position, open to applicants in United States.

📋 Description

• Obtain business rules from various internal Cotiviti teams.

• Collaborate with internal stakeholders to clarify the intent and context of rules.

• Design and create rule logic for integration into the Business Rules Management System (BRMS).

• Test and validate rules in non-production settings.

• Implement validated rules into production environments.

• Communicate outcomes of rule deployments and changes to operations and stakeholders.

• Maintain documentation and version history for business rules.

• Conduct impact analysis for newly created or revised rules.

• Perform root cause analysis and identify any gaps in audit or operational results.

• Recommend and implement corrective measures to enhance rule effectiveness.

• Identify and address technical limitations and performance constraints.

• Lead the design and integration of additional exclusions functionality.

• Partner with operations teams to disseminate rules and gather user feedback.

• Develop reports and insights regarding rule effectiveness, audit results, and content trends.

• Explore opportunities for automation and workflow improvements utilizing tools like Power Automate, JIRA, and Asana.

• Identify chances to transition support, training, or documentation tasks to downstream teams.

• Complete annual Performance Plan responsibilities along with assigned special projects.

⛳️ Requirements

• High School Diploma is required.

• A Bachelor’s degree in education, technical writing, communications, or related fields is strongly preferred.

• Equivalent experience may be considered in place of a degree.

• Experience in the healthcare sector is necessary.

• Basic coding skills with the ability to write and comprehend SQL, Java, or other programming languages.

• Familiarity with Access, HUE, Datameer, Power BI, or SQL Server Management Studio (SSMS).

• Knowledge of complex business rules and products like DROOLS in RedHat Decision Manager.

• Experience analyzing large datasets and auditing payment inaccuracies.

• Ability to work independently while collaborating with others.

• Strong analytical and problem-solving capabilities.

• Capacity to manage multiple tasks while adhering to deadlines and quality standards.

• Excellent organizational, communication, and presentation skills.

• Willingness to work varying shifts as needed.

• Proficient experience with Microsoft Word, Excel, PowerPoint, Visio, and Outlook.

• Ability to diagnose and resolve complex technical issues.

• Strong critical-thinking and complex-analysis abilities.

• Industry-specific knowledge of relevant technologies, systems, or products.

• Systems-thinking and pattern-recognition skills.

• Ability to prioritize technical problems effectively.

• Empathy, patience, and the ability to provide clear explanations when interacting with customers or users.

• Must provide a dedicated, secure work area.

• Must ensure high-speed internet access/connectivity and maintain an office setup.

• Must be capable of performing duties with or without reasonable accommodation.

🏝️ Benefits

• Discretionary bonus consideration.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays each year.

• 17–27 days of Paid Time Off (PTO) annually, based on level and length of service.

• Remote work arrangement.

• Dedicated and secure work area with office setup support requirements.