Healthcare Expert
2 weeks ago
At Metasys Technologies, we are seeking a skilled professional to join our team as a Healthcare Expert. This role requires a strong understanding of claims processing, with a focus on Pharmacy Benefit Management (PBM) and benefits testing.
Key Responsibilities:- Health Care Knowledge: Develop and maintain a deep understanding of healthcare claims processing, including PBM and benefits testing.
- Business Requirement Analysis: Analyze client business requirements and adjudication systems to ensure accurate processing.
- Client-Facing Communication: Maintain clear and effective communication with clients to ensure alignment on requirements and project expectations.
- Functional Specification: Create detailed functional specification documents based on client requirements.
- Review and Mapping: Review XMLs and collaborate on mapping documents between source and target systems.
- Configuration and Testing Guidance: Provide guidance to configuration and testing teams for requirements clarification.
- Defect Management: Support the defect management process, ensuring efficient issue resolution through the SFDC tool.
- Rxclaims: Analyze requirements and develop plans in Rxclaims while coordinating with coding and support teams.
- Offshore Coordination: Manage offshore teams, defect triage, and provide status reporting on risks and issues.
- Knowledge Management & Capability Development: Provide input for training and capability-building initiatives, identify training needs, and conduct internal sessions as necessary.
- Health Care Knowledge: Strong understanding of healthcare claims processing.
- Benefits Testing Experience: Minimum 4 years of relevant experience.
Metasys Technologies is an equal opportunity employer. We welcome applications from diverse candidates and are committed to creating an inclusive work environment.
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