- Hybrid
- 2–4 years
The role of SPE Claims HC focuses on analyzing and supporting healthcare product solutions within payer EDI environments ensuring accurate and efficient handling of electronic claims and related transactions.
Responsibilities
- Analyze healthcare product specifications and claims processing rules to ensure that payer EDI transactions are implemented accurately and conform to organizational standards and industry regulations
- Support end to end lifecycle of healthcare claims within payer EDI systems by monitoring transaction flows and identifying data or configuration issues that impact timely adjudication
- Collaborate with cross functional teams to translate business requirements from healthcare stakeholders into clear and testable functional specifications for EDI payer solutions
- Coordinate with technology and operations teams to validate that changes to healthcare products and claims rules are correctly implemented and do not introduce defects in EDI payer processes
- Conduct detailed root cause analysis for issues in healthcare claims and payer EDI transactions and document findings to enable sustainable corrective actions and knowledge reuse
Requirements
- Bachelor's degree in a related field