Description
Job Description:
- BCA NPR/Blue2 Messaging, adjustment processing, Claim Admin and aging
- Data Net reporting functions for all BOIDs
- DFEC processing for claims.
- Test plan creation
- Score card processing and how IS impacts the scores.
- The Company's mandated dates for global certification and the criteria need to meet said dates.
- Local system claims processing to include all interfacing applications such as BDS, Benefit Files, RULES, PIMS, etc.
- Understand the auxiliary files sent to the company (Providers, CDHP).
- Able to translate company codes such as TOS, POS to local claims system coding structure.
- Able to map local claims system codes to ITS coding structure and vice versa.
- Able to identify impacts (and any other plan we are processing) from company emails.
- Able to translate error code to local claims system error codes.
- Able to manually process claims on HPA
- Able to read and translate function specifications into scope and design documents.
- Able to research on the BlueWeb, create incident tickets and communicate with the company.
- Able to review defects and translate customer needs to the IS staff.
- Able to work with Recons from ALIM.
Required skills:
- Able to write complex test cases/scripts.
- Strong communication skills both written and verbal.
- Ability to work in a fast-paced environment.
- Strong analytical skills.
- Ability to work independently
- Must have good IT experience.