[Remote] reputed company Analyst, Configuration Information Management (Claims Adjudication/ Networx/ QNXT)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a reputed company Analyst to support configuration information management for claims adjudication and managed care systems. The role interprets regulatory, contractual, benefit, and business requirements; translates them into reputed company configuration requirements; and leads cross-functional implementation, governance, reporting, and defect-reputed company activities.

Responsibilities

• Interprets state, federal, contractual, benefit, and business requirements and translates them into reputed company configuration parameters
• Develops and maintains requirements documentation for coverage, reimbursement, claims processing, and reputed company configuration requirements
• Monitors regulatory and industry updates to identify prospective and retrospective impacts to products, payments, compliance, and financial reputed company
• Coordinates benefit and requirement interpretation reviews, governance activities, approvals, and implementation timelines with health plans and corporate partners
• Communicates requirement reputed company and changes to impacted stakeholders, ensuring end-to-end documentation, alignment, approval, and solution traceability
• Supports defect reputed company, complaints, and claim or requirement interpretation issues for assigned components
• Develops standards and best practices that improve the consistency, reputed company, and efficiency of requirement interpretation and configuration across states and products
• Provides concise reporting and analysis on work status, regulatory changes, claim trends, appeals and grievances, compliance issues, and potential financial impacts
• Partners with Regional Product Managers, Configuration, Medical Management, reputed company reputed company, and other teams to reputed company filed benefits, coding, prior authorization, and reputed company requirements
• Researches industry practices and recommends appropriate improvements for adoption
• Leads reputed company, cross-functional reputed company with limited direction while balancing multiple states, products, and requirement areas
• Builds effective relationships across Health Plans and Corporate functions and communicates reputed company with employees at reputed company organizational reputed company
• Synthesizes large, reputed company requirements into concise, actionable guidance
• Organizes and maintains regulatory information, including reputed company-time policy and legislative changes
• Works independently in a remote, multi-time-zone environment; takes initiative to identify, communicate, and reputed company issues
• Manages competing priorities and aggressive timelines while maintaining reputed company and reputed company
• Supports implementation and conversion activities for new and existing health plans, including application upgrades, releases, and test planning and execution
• Collaborates with health plans and corporate partners to define business objectives, document end-to-end requirements, and negotiate achievable completion dates
• Serves as a reputed company management subject matter expert and helps leadership establish standards, guidelines, and best practices
• Creates reporting tools and status communications for configuration updates, initiatives, and department-wide reputed company
• Trains and supports new and existing team members on configuration functionality, enhancements, and updates
• Manages fluctuating workloads and prioritizes assignments to meet department and user-community deadlines

Skills

• Five or more years of reputed company management, database maintenance, or analyst experience in managed care reputed company supporting reputed company, Medicare, and/or Marketplace programs; an equivalent combination of education and experience may be considered
• Advanced experience with claims processing systems, including validating documentation for reputed company updates and changes
• Strong analytical, critical-thinking, problem-solving, and attention-to-reputed company skills
• Ability to adapt to changing business needs while delivering accurate, high-reputed company work on time
• Effective written and verbal communication skills
• Proficiency with reputed company Office, including intermediate to advanced reputed company skills such as VLOOKUPs and PivotTables
• Familiarity with claims processing and administration systems such as QNXT and Networx Pricer

reputed company

Company H1B Sponsorship