Analysis Skills, Application Programming Interface (API), Best Practices, Communication Skills, Continuous Improvement, Customer Support/Service, Documentation, High Availability, IBM Product Family, IBM WebSphere MQ (Message Queue), Identify Issues, Insurance, Insurance Claims, JSON, Market Segmentation, Medicare, Options Analysis, Problem Solving Skills, Research Skills, Salesforce.com, Service Delivery, Time Management, XML (EXtensible Markup Language)
Description
Job Title: IBM ACE Developer
Pay Rate: $55-60/hr on W2
Schedule: 100% Remote
Position: Contract
Duration: 6 months (Possibility for extensions)
Employment Type: W2 (Due to client requirements this role is only open to permanent residents)
Job Description:
Must Have Skills:
- Experience in IBM ACE development is required
- Experience in IBM MQ, API development, XML, JSON, event-driven, Salesforce preferred.
- Bachelor's degree or advanced degree (where required)
- 5+ years of experience in related field.
- In lieu of degree, 7+ years of experience in related field.
Responsibilities:
- Respond promptly and accurately to inquiries from Customer Service
- Professionals, subscribers, providers, physicians and other insurance carriers regarding claims payments.
- Meet or exceed established quality and performance standards
- Determine suspended claim resolution methods by reviewing benefit eligibility, claims history and other information
- Escalate claims requiring specialized resolution to subject matter experts based on department policies and guidelines to
ensure the resolution
- Understand business requirement for the customer and provider segments with tailored solutions to their needs
- Identify system issues by documenting the issue, recommend potential solution and refer appropriate technical staff
- Work with designated Provider Services specialists to deliver services tailored to the provider services
- Review claims for possible "fraud and abuse" and send to Special Investigations Unit for additional investigation
- Use continuous improvement and knowledge of claims to drive efficiency and production gains; share best practices
- Coordinate with other insurance carriers and Medicare to determine payment liability
- Represent Claims interests on divisional or enterprise project teams
- Independently perform the analysis, design and development of high volume, low latency applications for mission critical
systems delivering high-availability and performance to best meet customer needs.
- Write well designed, testable, efficient code to support varied and more complex IT solutions
- Provide strong technical expertise and collaborate with other IT specialists to rapidly develop and deliver stunning solutions
that meets changing business needs.
- Perform all necessary discovery and fact finding to fully understand more complex business problems and opportunities and
independently execute all assignments.
- Evaluate options and make solution buy vs. build recommendations to management when requested.
- Analyze and recommend solutions to development and production issues while effectively communicating to the project team,
applicable vendors and/or the manager in a timely manner.
- Research and stay abreast of technology trends and IT best practices, with a focus on continuous learning and possible
application to the business.
- Provide direction and assistance to less experienced team members.