Senior Manager, Claims Technical Analyst, Medicaid Intake Operations

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

Job Description

Serve as the Technical Subject Matter Expert (SME) for intake rules and matching logic
Liaise with providers and internal teams to resolve questions about EDI and Claims Intake rejections
Provide second-level expert support for intake claim rejections
Analyze large datasets for research and troubleshooting
Collaborate with Product Owners and IT teams on system enhancements and fixes
Participate in testing and verification of business rules and validations
Manage multiple projects and tasks simultaneously while maintaining high-quality results
Support Product Owners, Business Owners, and Leads using technical and analytical expertise
Communicate effectively across all levels of the organization, including cross-functional teams
Write complex SQL queries to join multiple data sources and analyze data for root causes, trends, and opportunities
Analyze EDI and Claims intake rejections from internal and external inquiries, including provider calls
Track and execute solutions for identified issues
Perform User Acceptance Testing for logic changes and enhancements
Develop utilities, queries, and processes for post-production checkout of business rules and system fixes

5+ years of experience as a SQL Server power user (coding and developing data extracts)
5+ years of data interpretation and analysis experience
5+ years querying large datasets using SQL, SAS, or other data tools
Strong documentation skills; writing readable and reproducible code
Process improvement mindset; strives to simplify complex processes
Proficient in Word, PowerPoint, Excel
Experience working independently and prioritizing multiple deliverables
Experience managing conflicting priorities and concurrent projects
Excellent verbal and written communication skills with experience communicating technical information to non-technical audiences