Rating/Claims System Analyst
Anticipated End Date:
Position Title:
Rating/Claims System Analyst
Job Description:
Rating/Claims Systems Analyst Hybrid 1:
This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals.
While our roles may differ, our purpose is shared: to make a positive impact on whole health.
The Rating/Claims Systems Analyst will be responsible for providing support, configuration, design, testing and implementation for ratings or claims systems.
How you will make an impact:- Responsible for collaborating with cross-functional stakeholders, including business partners, Product Owners, developers, Quality Engineering teams, and vendors, to ensure solutions meet business and technical requirements.
- Demonstrates experience with healthcare prepayment claims editing platforms, including rule configuration, editing logic, implementation, testing, and ongoing maintenance.
- Strong understanding of healthcare reimbursement methodologies, payment integrity, medical policy application, and industry coding standards, including ICD-10, CPT, and HCPCS.
- Demonstrates experience translating business and system requirements into comprehensive test scenarios and test cases.
- Works with business owners to identify and analyze requirements and processes with Information Technology and the vendor to ensure quality and timeliness of systems/project deliverables.
- Configures new designs/updates in the system.
- Monitors system and business functionality and performance.
- Documents and tracks product defects.
- Coordinates problem resolution with development and/or product vendors.
- May implement rates, rating formulas, product and benefit configuration/information and as directed by the appropriate business unit.
- Analyzes, develops and validates data.
- Researches, documents and completes simple to moderately complex projects and work processes to ensure business continuity and consistency.
- Formulates and defines system scope and objectives based on user-defined requirements.
- Supports and maintains the systems post-implementation.
- Provides end user support, consultation, liaison communications, helpdesk triage, training, reporting, auditing, application security, and ad hoc inquiries and requests.
Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 2 years systems analyst or business analyst experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:- Experience with test planning, coordination, and execution preferred.
- Three or more years of experience leading end-to-end User Acceptance Testing (UAT), including: (Test strategy and planning, Test scenario and test case development, Test execution, Defect management and validation, Production readiness activities, Code editing and…
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