Adjudication, Business Analysis, Claims Processing, Communication Skills, Compensation and Benefits, Data Quality, Data Sets, Electronic Data Interchange (EDI), Graphical User Interface (GUI), Healthcare, Mail Services, Medicaid, Medicare, Multitasking, Presentation/Verbal Skills, Product Demonstration, SQL (Structured Query Language), Software Testing, Systems Analysis
- Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
- Candidate should have hands-on experience on claims processing and Adjudication processes.
- Must have good experience in Reference code/data sets required in Claims adjudication.
- Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
- Should be able to run queries and perform basic system analysis, RCA etc.,
- 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
- Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
- Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
- 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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