HealthEZ

Operations

• Gather and develop business requirements to ensure claim processing produces the desired outcomes
• Build claim requirements and provide to other departments, vendors and key stakeholders initiating other projects to ensure other understand what the claims department needs to be successful
• Develop claim test scenarios and test plans
• Responsible for comparing current business practices and systems with the desired future state
• Document results, findings, and solutions.
• Complete the claim testing in the various test environments and upon test sign off validate specific outcomes continue within production
• Lead the Investigation of reported incidents, including performing root cause analysis, communicating with affected stakeholders, and designing and implementing internal controls to prevent similar incidents from occurring in the future.
• Collaborate and coordinate with cross function teams to identify and propose actionable solutions
• Accountable to resolve issues, defects and concerns related to testing
• Responsible for analyzing large data sets to find efficiencies and make recommendations on solutions to improve claims processes.
• Effectively communicate with team members, vendors, and stakeholders.
• Oversee the test environments in collaboration with Plan build, IT and VBA to ensure environment is refreshed and ready for successful execution of testing.
• Document outcomes and train others on developed solutions.

Claims Operations Analyst