|7+ years of experience working in an operations role at a health plan|
4+ years of Healthcare experience in any of the following:
Government Programs, PBM, Clinical Health Management, Core Administer Delivery, Program Management, Product Management, or Network Management
2+ years of experience in one or more of the following:
Operational business process improvement, business process analysis, benchmark analysis or workflow analysis
Ability to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc.
Knowledge and experience of Medicare & Medicaid state level reporting levels
Strong Knowledge/Experience with Dimensional Modeling
Strong understanding of healthcare data formats, standards, and can map them to CMS and state level reporting needs
Good understanding on the lifecycle of claims adjudication
Possess good exposure on the various claim functionalities such as Edits, COBs, claims adjustments, Episodes etc.