Associate

Tegria

22h•Remote

About The Position

Tegria is seeking Associate Payer Consultants to bridge the gap between technology, regulatory requirements, and operational processes within health plans. In this role, you will support the implementation, optimization, and management of various payer platforms, including claims processing systems, core administration systems, member enrollment/eligibility platforms, care management/utilization management tools, provider network systems, and analytics/reporting solutions. As a consultant, you will guide healthcare clients in leveraging technology to achieve their specific goals, contributing to a range of engagements from strategy and implementations to process improvement. You will have the opportunity to work independently or as part of a team, on multiple assignments or focusing on a single project based on business needs. Beyond client work, you will mentor team members, support internal initiatives, and contribute to business growth. Success in this role requires strategic thinking, clear communication, and the ability to adapt quickly.

Requirements

Related bachelor’s degree or equivalent combination of education and experience.
Committed to pursuing relevant certifications to stay competitive and credible.
Typically has 2 - 4 years of related experience, including: Payer operations such as claims, benefit configuration, provider data, enrollment/eligibility, utilization management, or reimbursement.
Commercial payer platforms or modules.
Project management tools and methodologies.
Successful record of meeting deadlines, working from a project plan, and delivering per milestones.
Experience in system integration, workflow redesign, or change management.
Foundational knowledge in one or more of the following: Payer operations, benefit structures, payment methodologies (fee-for-service, capitation, value-based), and provider contracting.
Interoperability and data exchange (EDI, HL7, FHIR) and integration with provider systems and clearinghouses.
Databases (SQL), rules engines, and automation solutions used in payer systems.
Compliance frameworks including HIPAA, CMS program integrity rules, and state regulatory requirements.
Familiar with Agile, Scrum, or other project management frameworks.
Keeps current with trends in healthcare technology and regulations.
Have reliable internet access and sufficient speed to perform the job satisfactorily.
Able to work under general direction with latitude for independent judgment.
Proficiently use Office Productivity and Collaboration Tools (e.g., O365).
Analyze and solve complex problems with practical, compliant solutions.
Manage small projects using proven methods (e.g., status reports, metrics, change management).
Translate complex technical ideas into clear, client-friendly language.
Communicate effectively in writing, conversation, and facilitate small group meetings.
Create reports, proposals, emails, and technical documents.
Handle multiple priorities and adapt to shifting needs.
Demonstrate professionalism and build strong client relationships.
Influence stakeholders and guide decision-making effectively.
Attend work reliably.
Work effectively under stress, including emergent/urgent situations and priority changes.
Participate in verbal communications in real time with individuals and groups via phone and video conferencing and in person, while being understood clearly and hearing others correctly.
Use vision sufficient to discern all relevant elements displayed on paper or screens.
Operate computer, keyboard and phone efficiently and effectively.
Has cognitive ability sufficient to learn, comprehend, retain, recall, and consistently apply information necessary to perform the job satisfactorily and to read and comprehend policies and procedures.
Has reasoning ability sufficient to gather relevant data, define problems, establish facts, draw valid conclusions.
Able to sit for more than two-thirds of the time as in an office job.
Able to stoop and bend to plug in computer equipment at home, office, customer site.

Nice To Haves

Certification in one or more Epic Cogito application(s)
Demonstrated success in small project/engagement management
Prior consulting experience

Responsibilities

Analyze payer workflows—claims adjudication, enrollment/eligibility, member services, provider data management, prior authorization/UM, reimbursement, coordination of benefits, and appeal/grievance processes—to identify gaps and recommend improvements.
Support implementation or optimization of payer platforms.
Configure benefits, provider contracts, fee schedules, and adjudication rules to ensure accurate claims processing and compliance.
Support integration efforts across payer systems, including clinical data exchange, provider systems, clearinghouses, and regulatory reporting.
Assist with structured testing (UAT, integration, regression) to validate benefit configuration, claim workflows, accumulators, and payment accuracy.
Collaborate with operational leaders in Claims, Member Enrollment, Provider Relations, Care Management, and Finance to collect requirements, validate workflows, and support change adoption.
Provide post-go-live support, triage issues, analyze claims errors or benefit mismatches, and implement corrective actions.
Monitor compliance with payer regulations (CMS, state DOI, NCQA, HIPAA transactions such as 834/837/835).
Develop operational documentation—benefit configuration specs, process flows, troubleshooting guides, and training materials.
Deliver high-impact consulting services tailored to healthcare environments.
Serve as team member or independent contributor.
Understand client needs and offer tailored solutions.
Collaborate cross-functionally to meet timelines and milestones.
Facilitate communication between stakeholders to align outcomes.
Proactively manage expectations and mitigate miscommunication.
Track key decisions and support change management initiatives.
Analyze current workflows to identify and resolve system gaps.
Configure, test, train, and implement systems.
Assist with testing.
Create and follow work plans to meet quality and time expectations.
Measure outcomes and communicate value through reporting.
Identify, escalate, and mitigate risks related to scope, resources, or timelines.
Communicate mitigation strategies clearly and early.
Mentor client teams to support knowledge retention and autonomy.
Align on priorities, timelines, and outcomes; confirm shared understanding.
Align all work with client goals and service line strategy.
Support team members.
Share knowledge, tools, and best practices to support innovation.
Contribute to internal initiatives aligned with organizational goals.
Identify and share potential business opportunities.
Help develop content for proposals and marketing.
Perform other duties as assigned.