Ops Configuration/Integration Analyst

Centene Management Company • Woodland Hills, CA

1d • $27 - $49

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT Position Purpose: The Operations Configuration and Integration Analyst creates, updates, tests and maintains system configuration tables and files to support accurate claims adjudication in a multiple product, multiple state, managed care environment. Analyzes, interprets, loads, tests and maintains configurable tables, files and software that are utilized to support claim adjudication which include and but are not limited to claim adjudication rules edits, benefit plan support, and provider reimbursement rules. Assists in development and execution of testing scenarios, test conditions. Performs unit and/or end user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes as necessary that effects claim adjudication rules. Proactively identifies opportunities and recommends system solutions that increase automation, resolves system deficiencies and enhance claims processing to meet and exceed business requirements. Stays abreast of company business strategies and marketplace trends to ensure business decisions meet future needs. Researches and resolves claim problems or issues that are configuration related in a timely and accurate manner. Develops system queries to determine the scope of the problem and recommends possible solutions to management. Technical reference for other areas in translating system specifications and operations. Interacts and coordinates system programming changes and schedules as necessary with the IS Business Analysts and Programmers. Develops and maintains a comprehensive knowledge of the claims adjudication rules, MC400 editing and claim processing programs, Macess imaging system and claim related software packages that are utilized in claims adjudication. Performs other duties as assigned Complies with all policies and standards

Requirements

• Bachelor’s Degree or an equivalent combination of education and experience in a managed care environment.
• Minimum two to three years experience in an automated medical claims environment and managed care/multiple product environment desired.
• Minimum one to two years experience in systems logic and testing desired

Responsibilities

• Creates, updates, tests and maintains system configuration tables and files to support accurate claims adjudication in a multiple product, multiple state, managed care environment.
• Analyzes, interprets, loads, tests and maintains configurable tables, files and software that are utilized to support claim adjudication which include and but are not limited to claim adjudication rules edits, benefit plan support, and provider reimbursement rules.
• Assists in development and execution of testing scenarios, test conditions.
• Performs unit and/or end user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes as necessary that effects claim adjudication rules.
• Proactively identifies opportunities and recommends system solutions that increase automation, resolves system deficiencies and enhance claims processing to meet and exceed business requirements.
• Stays abreast of company business strategies and marketplace trends to ensure business decisions meet future needs.
• Researches and resolves claim problems or issues that are configuration related in a timely and accurate manner.
• Develops system queries to determine the scope of the problem and recommends possible solutions to management.
• Technical reference for other areas in translating system specifications and operations.
• Interacts and coordinates system programming changes and schedules as necessary with the IS Business Analysts and Programmers.
• Develops and maintains a comprehensive knowledge of the claims adjudication rules, MC400 editing and claim processing programs, Macess imaging system and claim related software packages that are utilized in claims adjudication.
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level