Overview
Remote
Depends on Experience
Part Time
Skills
HealthRules
HealthEdge
claims processing
claims configuration
Auditing
Collaboration
Management
Root Cause Analysis
claims issues
Job Details
Job Description:
We are nearing the final stages of launching a project that requires a highly skilled HealthRules Architect / SME with specific expertise in claims configuration. This is a strategic role focused on identifying and resolving issues related to claims processing by working in close collaboration with operations and technical teams.
Key Responsibilities:
- Lead and manage configuration tasks within HealthRules, with a strong emphasis on claims processing.
- Collaborate with both operations and technical teams to identify and troubleshoot claims-related issues.
- Develop and implement mitigation plans to resolve claims configuration problems.
- Conduct claim audits and provide in-depth root cause analysis.
- Serve as the primary SME to guide teams on best practices for claim configuration and resolution.
Required Experience:
- Proven hands-on experience with HealthRules, specifically in claims configuration.
- Demonstrated ability to work cross-functionally with operations and IT teams to address and resolve claims issues.
- Experience in performing claim audits and conducting thorough root cause analysis.
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