Claims Systems Tester - Hybrid/Remote
About The Position
This position is responsible for the direct claims testing of all new system implementations, updates to existing systems, and alterations of any kind that impact claims processing in any way. This position will identify criteria needed to find appropriate testing scenarios, plan and activate test cases for the identified situation, determine if testing is a pass or a fail and why, document all test cases and results, communicate with Claims Management as to the results of the test cases and identify potential needs and/or solutions. This position also researches system errors and identifies solutions to implement or correct the system. This position is responsible for testing all types of system adds, changes, deletes that impact Claims Processing to improve claim outcomes with greater efficiency.
Requirements
- High school graduate from an accredited school or equivalent.
- Minimum of five (5) years managed care experience with a minimum of (2) years of direct experience in processing all medical claim types on a UB04 and CMS1500 in a Managed Care Organization.
Responsibilities
- Analyze, perform and validate in the system testing of new contract configuration and enhancements of existing contract configuration of the core claims processing system to ensure they meet the business specifications and needs.
- Analyze, perform and validate in the functionality testing of any update to the core claims processing system as they relate to the claims department to ensure they are functioning as expected through end-to-end scenario testing
- Perform in regression testing of any changes to the core claims processing system to identify any possible impacts caused by changes.
- Review and update the maintenance and management of test scripts
- Assist running reports to quantify Claim reported issues
- Run reports for the overpayment team, once reported issues have been corrected
- Assist with logs to track reported issues
- Analyze reports to identify areas that can potentially increase auto adjudication
- Analyze and recommend corrections to the system functionality based on testing of reported errors.
- Performs other job-related duties as required.
- Adheres to all company policies and procedures relative to employment and job responsibilities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
