Computer Systems Analyst
Core
Lead claims domain analysis for Medicaid/Medicare MMIS projects, translating regulatory requirements into implementation solutions for healthcare financial operations.
Role type
Senior Computer Systems Analyst (Healthcare Claims)
Builds
MMIS claims processing and adjudication systems, benefit configurations, and payment cycles for Medicaid/Medicare programs.
Domain
Healthcare / Insurance / Government Benefits
Required skills
SQL, EDI X12, interface testing, Postman, data validation, requirements analysis, traceability, root-cause analysis, system analysis, claims lifecycle analysis, benefit configuration, claims adjudication, payment processing, integration across subsystems
Preferred skills
MMIS claims systems experience, benefits configuration, reference data management, payer processes, claims-related subsystems, client collaboration, cross-functional team coordination
Technologies
Postman, SQL
Responsibilities
Lead claims domain analysis for MMIS projects covering requirements, lifecycle processes, business rules, and implementation decisions; Analyze and document claims requirements, workflows, interfaces, benefit configurations, and system functionality; Collaborate with clients and development/QA teams to resolve issues, validate requirements, and manage stakeholder feedback; Conduct system and data analysis, support root-cause analysis, and review test scenarios.