Description

You will provide analytical support for business applications, infrastructure, and technology activities within the healthcare domain.

Responsibilities

• Analyze current business processes and systems to propose process improvement ideas.
• Gather requirements and develop detailed documentation for system requirements and conceptual solutions.
• Lead cross-functional areas and coordinate with testing centers and various prime and non-prime departments.
• Manage complex problems by providing guidance, coordination, and follow-up to ensure resolution.

Required Skills

• 5+ years of experience in Utilization Management and business functions, including Claims, NPS, Benefits, Pricing, and Authorizations.
• Extensive claims and benefits experience (NPS).
• Proven experience in analysis and design, including process flow development using Visio.
• Healthcare industry experience.
• Knowledge of SDLC methodologies, including Waterfall and Agile.
• Experience submitting CSRs and following up with NASCO.
• Proficiency with MS Office tools and Visio.
• Ability to manage multiple projects concurrently.

Preferred Skills

• Strong problem-solving, conflict management, and interpersonal leadership skills.

Key Skills

Education

Bachelor’s Degree