Vacancy expired!
You could be the one who changes everything for our 24 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national Fortune 50 and rapidly growing organization, our mission is fueled by exceptional talent. To support our rapid growth, we are building our East Coast headquarters and innovation hub here in Charlotte. About Us: We are revolutionizing the world of healthcare through digital transformation and building a world-class software engineering practice. Our high caliber team delivers leading edge technology and drives innovation to solve complex business challenges. Using collective innovation we are turning visions into action and challenging what is possible to support the healthcare of 1 in 15 individuals. About You: You are a highly collaborative, strategic risk-taker driven to make a difference and change the face of healthcare. You thrive in a supportive, result-oriented community and are committed to the relentless pursuit of continuous growth. You are highly agile, excel in fast-paced environments and willing to push outside your comfort zone. You are ready to find your purpose at work The Role We are transforming technology and creating a digital evolution that will empower Centene to better serve our members. Senior Operations Configuration and Integration Analyst will create, update, test and maintain system configuration tables and files to support accurate claims adjudication in a multiple product, multiple state and managed care environment. Act as a liaison with specified user areas to define business requirements and processes for project deployment. Analyze information and develop specification documents to support updating, testing and maintaining configuration tables in the claims adjudication system. This role supports both product, benefit, and pricing in NYS for managed care, Medicare and Exchange Products. As Senior Operations Configuration and Integration Analyst you will:
- Gather requirements and develop specification documents
- Analyze, interpret, load, test and maintain configurable tables
- Edit files and software that are utilized to support claim adjudication which includes, but is not limited to, claim adjudication rules edits, benefit plan support, and provider reimbursement rules
- Assist in development and execution of testing scenarios and test conditions
- Perform unit and/or end user testing for new configuration, programming enhancements, new benefit designs, new provider contracts, and software changes as necessary that affect claim adjudication rules
- Proactively identify opportunities and recommend system solutions that increase automation, resolve system deficiencies and enhance claims processing and reporting to meet and exceed business requirements
- Research and resolve claim problems or issues that are configuration related in a timely and accurate manner
- Develop system queries to determine the scope of the problem and recommends possible solutions to management
- Interact and coordinate system programming changes and schedules as necessary with the IS Business Analysts and Programmers
- Assist with training new and existing staff
- Bachelor's Degree in Computer Science or related area or equivalent experience.
- 3+ years' experience in an automated medical claims environment and managed care/multiple product environment and 2+ years' experience in systems logic and testing is preferred.
- Experience with Facets, NetworX, SQL and Microsoft Office is a plus.
Vacancy expired!