Claims System Configuration Senior Analyst - eviCore - Remote

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Requirements:

• High School Diploma or GED required; bachelor’s degree preferred.
• 5+ years of healthcare claims lifecycle experience, including configuration design and analysis.
• 3+ years of experience in MS ACCESS and SQL querying.
• 3+ years of advanced experience with MS EXCEL.
• 3+ years of experience with database management systems, creating test plans/use cases, and SDLC models.
• 3+ years of experience in claims adjudication and understanding of claims data types and editing rules.
• Experience with MC400, McNet, and RC3 systems preferred.

Responsibilities:

• Resolve non-routine issues escalated from leadership, business, clients, and junior team members.
• Act as a subject matter expert (SME) for eviCore claims product setups and processes.
• Collaborate with internal and external clients to evaluate processes and identify procedural gaps.
• Analyze business and user requirements to design solutions and system configurations.
• Create test plans/use cases, perform SI testing, end-to-end testing, and improve adjudication automation.
• Partner with technology and analytics teams to develop new data sources for reporting.
• Act as a liaison between business and technology to execute project initiatives and resolve issues.