Claims Systems Lead Analyst - EviCore - Remote
Core
Manage complex claims systems projects and implementations within the claims adjudication engine, ensuring data integrity, security, and process optimization for EviCore claims processing.
Role type
Senior Claims Systems Lead Analyst
Builds
Claims processing systems and configurations for health insurance clients
Domain
Health Insurance / Claims Adjudication
Required skills
Claims lifecycle knowledge, Claims adjudication framework, Microsoft SQL, Microsoft Access Database, Microsoft Excel, Database management (DB2, SQL Server), ICD/CPT/HCPC/Rev Codes/NCCI data standards, Test planning and SDLC models
Preferred skills
Medical claims systems configuration, External client-facing experience, Azure DevOps, Mentorship
Technologies
Azure DevOps, Microsoft SQL, Microsoft Access, Microsoft Excel, DB2, SQL Server
Responsibilities
Manage complex claims systems projects and implementations; Mentor Sr. Analysts on enhancement and configuration designs; Lead external client calls to support the Claim System application; Define business, technical, and claim data exchange requirements; Create test/use cases and perform SI/UA testing; Create complex SQL queries to review configuration and data; Make updates to configuration via Access Database; Run post-production reviews and investigate claim processing root causes.
Seniority
Senior, hands-on IC with mentorship responsibilities