Technical Analyst – Claims Automation

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

📋 Description

• Identify scenarios involving a high volume of manual claims and assess opportunities for automation.

• Design and implement enhancements for automation within the claims processing system.

• Collaborate with engineering teams and vendors, including Mphasis, to enhance systemic and auto-adjudication capabilities.

• Analyze claims workflows and system logic to pinpoint inefficiencies and propose improvements.

• Convert business requirements into technical solutions that adhere to claims processing standards.

• Document workflows for automation, business rules, and system configurations.

• Monitor metrics related to auto-adjudication performance and identify areas for improving turnaround time and accuracy.

• Assist in the testing and validation of system changes and enhancements related to automation.

• Exhibit a commitment to our core values of authenticity, curiosity, creativity, empathy, and being outcome-oriented.

• Support EDI workflows and resolve transaction issues, including 837 claim submissions and 835 remittance files, in collaboration with the EDI team.

⛳️ Requirements

• Over 3 years of experience in claims systems, business analysis, or healthcare IT.

• Familiarity with claims adjudication processes and system workflow logic.

• Proficient in SQL or similar tools for data analysis and system performance evaluation.

• Experience in recognizing and implementing process automation or system improvements.

• Capability to translate complex business challenges into technical requirements.

• Strong analytical and problem-solving skills, with a keen eye for detail.

• Experience in cross-functional collaboration with engineering, operations, and vendor partners.

🏝️ Benefits

• Coverage for alternative medicine.

• Flexible paid time off (PTO).

• Up to 16 weeks of paid parental leave.

• Paid holidays.

• 401k retirement program.

• Transportation benefits.

• Education reimbursement.

• Two days of paid paw-ternity leave.