Responsibilities
- Develop detailed configuration models based on plan documentation and established standards.
- Construct, verify, and evaluate benefit structures for medical and dental plans, including coding logic integration.
- Update plan configurations and adjust logic when plan amendments occur.
- Design and test auto-adjudication rules to ensure compatibility with benefit plans.
- Address system errors and serve as the point of contact for managing tasks in the core claims system workflow.
- Evaluate and debug updates from new releases of the core claims platform before deployment to live environments.
- Identify root causes of technical issues and create corrective actions or temporary solutions.
- Collaborate with management and team leads to enhance operational effectiveness.
- Coordinate efforts to resolve system limitations that interfere with automated or standard processing workflows.
- Inform internal teams of system modifications and assist in training related to new configurations.
