1. Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
2. Candidate should have hands-on experience on claims processing and Adjudication processes.
3. Must have good experience in Reference code/data sets required in Claims adjudication.
4. Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
5. Should be able to run queries and perform basic system analysis, RCA etc.,
6. Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
7. Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
8. Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
9. In depth understanding of Claims and Claims lifecycle
Technical Skills
SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
EDI Tools: Validating X12 files.
Interface Testing: Understanding how data flows between systems and formats and use tools like postman
Numbers & Facts
Location
Atlanta, GA (Remote)
Skills
Adjudicationunmatched
Business Analysisunmatched
Claims Processingunmatched
Communication Skillsunmatched
Compensation and Benefitsunmatched
Data Qualityunmatched
Data Setsunmatched
Electronic Data Interchange (EDI)unmatched
Graphical User Interface (GUI)unmatched
Mail Servicesunmatched
Medicaidunmatched
Medicareunmatched
Multitaskingunmatched
Presentation/Verbal Skillsunmatched
Product Demonstrationunmatched
SQL (Structured Query Language)unmatched
Software Testingunmatched
Systems Analysisunmatched
🎯
Be found by employers
5,500+ employers search our resume database daily. Add yours to get found by recruiters looking for candidates like you.
Level up your application
Professional resume templates
Browse dozens of recruiter approved resume templates, layouts and formats. Choose your favorite and make it your own in minutes.