Company :

United Concordia Dental

Job Description :

JOB SUMMARY

Analyze, design, and code new clients/groups or products, maintenance of existing groups/products, corporate projects, strategic initiatives, benefit enhancements, and application of medical policy. Analyze data to determine business problem, trends, or opportunities for process improvements. Provide root cause analysis and corrective action plans. Provide production support via defect fixes, CRs or any other related issue. Provide subject matter expertise to various teams.

Responsible for verification that the delivered application code meets the customer needs based on the specifications, ensuring minimal defects in both UAT and production. Accountable for identification, documentation, and escalation of risks, defects and issues throughout the project lifecycle. Responsible for assisting in the resolution of risks, defects and issues. For smaller projects or initiatives may be accountable for project schedule and resource allocation up to and including matrix staff. May have accountability to provide project status back to the appropriate Management group or customer, release co-coordinator and/or various PMO groups.

ESSENTIAL RESPONSIBILITIES:

• Work with customers, application developers, architects, project management and team members to understand business requirements that drive the analysis and design of quality business solutions. Communicate effectively to explain technical benefits, application of medical policy, and claims processing capabilities and functionality.

• Work independently or a team member, to develop benefits and medical policy coding applications/solutions and perform project activity. Provide required business and/or subject matter expertise for both project and production related activities. May also participate as a subject matter expert in strategy development for new strategic programs.

• Research claims processing problems, perform initial problem identification and resolution activities and debug benefits and medical policy program coding. Document the results of problem analysis/research and prepare the specifications necessary to identify impacted claims.

• Provide assistance on development of project deliverables – e.g. vision documents, business requirements, use cases, supplemental specifications, user design, testing plan, testing schedule, testing scenarios, testing outcomes, approvals, and training materials.

• Manage job tasks and project requirements so that work is completed on time, in scope, within budget, and with minimal defects.

• Perform root cause analysis and coding implementation to include:

• Testing

• Data clean-up

• Business procedures implementation (suspense correction)

• Business/Technical sign-off on CRs and projects

• Follow coding structured protocols and maintain coding documentation. Perform system testing for coding group and production applications. Assist in development of testing plan, scenarios, documentation and defect management to ensure minimal production defects are realized. Complete analysis of the results tying back to customer impacts. Interface closely with the business and technical staff during all phases of a project, including unit and system testing, integration and UAT testing culminating with implementation checkout and post implementation support

• Other duties as assigned or requested.

QUALIFICATIONS:

Minimum

• High School Diploma

• 0-1 years of relevant subject matter experience in the area of specialization

Preferred

• Bachelors Degree in MIS, Computer Science, Business

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$22.71

Pay Range Maximum:

$35.18

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J253846