Claims Management Analyst III, HealthPlan EDI Experience Required
Job Description: • Manage the EDI (Electronic Data Interchange) trading partners and network of clearinghouses to ensure accurate and timely exchange of information • Work closely with Vendor Management to improve and maintain trading partner agreements • Provide Subject Matter Expertise (SME) to all departments regarding eBusiness specific EDI transactions • Build, sustain and leverage relationships to allow for continuous improvement of the EDI business process • Responsible for eBusiness EDI requirements that support regulatory, compliance, and business needs • Provide critical reporting and analysis of functional performance • Review and analyze the effectiveness and efficiency of existing processes and systems Requirements: • Bachelor’s degree or equivalent years of relevant work experience is required • Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required • Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.) • Advanced computer skills • Data analysis and trending skills to include query writing • Working knowledge of managed care and health claims processing • Must be able to effectively interact with all levels of management within the organization and across multiple organizational layers Benefits: • Health insurance • 401(k) matching • Flexible working hours • Paid time off • Substantial and comprehensive total rewards package Apply tot his job