Rating/Claims System Analyst

Elevance Health•Nashville, TN

3d•$65,680 - $94,415•Hybrid

About The Position

The Rating/Claims Systems Analyst will be responsible for providing support, configuration, design, testing and implementation for ratings or claims systems. Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.

Requirements

Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 2 years systems analyst or business analyst experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Experience with test planning, coordination, and execution preferred.
Three or more years of experience leading end-to-end User Acceptance Testing (UAT), including: (Test strategy and planning, Test scenario and test case development, Test execution, Defect management and validation, Production readiness activities, Code editing and claims knowledge) preferred.
Three or more years of experience as a Systems Analyst, Business Analyst, or User Acceptance Testing (UAT) Analyst supporting large-scale, enterprise technology implementations, preferably within healthcare claims editing preferred.
Experience with requirements elicitation, analysis, and documentation preferred.
Analytical thinking and problem-solving preferred.
Process improvement and test automation experience preferred.
Strong written and verbal communication skills.
Ability to manage multiple priorities in a fast-paced environment.

Responsibilities

Collaborating with cross-functional stakeholders, including business partners, Product Owners, developers, Quality Engineering teams, and vendors, to ensure solutions meet business and technical requirements.
Demonstrates experience with healthcare prepayment claims editing platforms, including rule configuration, editing logic, implementation, testing, and ongoing maintenance.
Strong understanding of healthcare reimbursement methodologies, payment integrity, medical policy application, and industry coding standards, including ICD-10, CPT, and HCPCS.
Translating business and system requirements into comprehensive test scenarios and test cases.
Works with business owners to identify and analyze requirements and processes with Information Technology and the vendor to ensure quality and timeliness of systems/project deliverables.
Configures new designs/updates in the system.
Monitors system and business functionality and performance.
Documents and tracks product defects.
Coordinates problem resolution with development and/or product vendors.
May implement rates, rating formulas, product and benefit configuration/information and as directed by the appropriate business unit.
Analyzes, develops and validates data.
Researches, documents and completes simple to moderately complex projects and work processes to ensure business continuity and consistency.
Formulates and defines system scope and objectives based on user-defined requirements.
Supports and maintains the systems post-implementation.
Provides end user support, consultation, liaison communications, helpdesk triage, training, reporting, auditing, application security, and ad hoc inquiries and requests.