Adjudication, Business Analysis, Claims Processing, Communication Skills, Compensation and Benefits, Data Quality, Data Sets, Electronic Data Interchange (EDI), Graphical User Interface (GUI), Mail Services, Medicaid, Medicare, Multitasking, Presentation/Verbal Skills, Product Demonstration, SQL (Structured Query Language), Software Testing, Systems Analysis
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
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