Rating/Claims Syst Adv (US)
Elevance Health

Job Info

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Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Senior Implementation Specialist will have expert-level experience in Payment Integrity and will be responsible for implementing payment integrity concepts and executing on all activities related to providing support, configuration, design, testing and implementation for ratings or claims systems. The role requires a candidate with a strong understanding of data analysis, claims processing, and audit processes associated with healthcare payment models.

How you will make an impact:

• Develop, implement, and maintain payment integrity edits to drive cost saving results.
• Works with business owners to identify and analyze requirements and processes with Information Technology and deploy the requirements to ensure quality and timeliness of systems/project deliverables.
• Configures new designs/updates in the system.
• Monitors system and business functionality and performance.
• Documents and tracks product defects.
• Coordinates problem resolution with development and/or product teams
• Analyzes, develops, and validates data.
• Researches, documents, and completes very diverse and complex projects and work processes to ensure business continuity and consistency.
• Formulates and defines system scope and objectives based on user-defined requirements.
• Build and maintain robust project documentation, including implementation plans, progress reports and post-implementation reviews.
• Troubleshoot system issues, implement solutions and manage escalation processes.
• Provides expertise to more junior analysts.

Minimum Requirements:

Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 6 years systems analyst or business analyst experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Master's degree in Business Administration, Computer Science, Healthcare Administration, or related field preferred.
• Extensive knowledge in payment integrity, claims analysis, and healthcare payment models.
• Agile experience strongly preferred.

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