Description
Claims Analyst needed in Lake Oswego, OR - WE WANT TO TALK TO YOU!
As a global business and technology consulting services leader, Enclipse focuses on delivering tangible solutions.
By employing a team committed to questioning and challenging the status quo, Enclipse has established a culture that encourages independent thought, innovation, and flexibility.
If you join Enclipse, you can expand your technology platform while working for the Nation's most dynamic Health Care Leader.
We Provide:
- Class A Benefits that Start ASAP
- The Personal Touch -- You deserve it, We deliver it!
Contract Terms: W2
7 + Months
Position:
We are seeking a seasoned, self-motivated and results-driven IT Professional who can make it happen no matter what challenges are encountered along the way. An outside the box thinker who will always find creative ways to lead the solution design work on complex IT Projects in the EDI & Claims domain.
The EDI & Classic Claims Solution Design group is responsible for driving and completing the analysis and logical design work on all IT Projects, which impact the EDI and Claims domain. Our portfolio of applications includes both in-house developed and Vendor products, representing a full suite of a highly integrated and complex EDI and Claims environment, spanning multiple technologies and platforms.
The Solution Consultants study the overall business and information needs of an organization, in order to develop solutions to business and related technology problems. This includes consulting with Business Partners to define requirements and develop solution alternatives and estimates (Business Engagement Consultants) and translating client's business requirements into specific systems, applications or process designs for large complex IT solutions and integrating architecture (Solution Consultants) and assuring the integration of corporate business application architectures.
JOB RESPONSIBILITIES:
Lead business and technical analysis efforts
Independently Plan and Execute JAR/JAD sessions following a pre-defined structured and methodical approach
Responsible for understanding current systems & their functional capabilities.
Conduct business requirement and gap analysis sessions
Develop use cases, and user requirement specification documents.
Identify and evaluate solution alternatives
Develop high level technical designs
Liaise with developers, business analysts, and user representatives in application design reviews.
Work closely with Project Manager to create and maintain the workplan
PROJECT INFORMATION:
1. Part C EOB: A CMS regulatory requirement mandating that all Medicare Advantage Organization produce monthly Explanation of Benefits (EOBs) to the plan enrollees
2. Administrative Simplification HCR: A regulatory project to implement CAQH Operating Rules
3. Other - TBD
Can the contractor work remotely or do they need to be onsite.
Onsite with possibility to work remotely 2-3 days dependent on performance which will be assessed after 4 weeks from onboarding