Claims Application Analyst
Shyft6
contract
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $70 per hour
Job Level
Mid-LevelSenior
About the role
- Lead and support Tapestry Claims build, configuration, testing, and deployment activities.
- Analyze requirements related to claims processing, benefit structures, contract configuration, and adjudication rules, translating them into scalable system designs.
- Troubleshoot claims errors, pricing discrepancies, configuration gaps, and end-to-end adjudication issues.
- Collaborate with operational teams (Claims, Provider Relations, Contracting, UM/CM, Finance) to optimize workflows and resolve system defects.
- Configure and maintain benefit plans, coverage records, provider contracts, fee schedules, claim edits, accumulators, and reimbursement logic.
- Support integration points with related Epic modules such as Membership, Enrollment, Referrals, PB/HB, and external payer systems.
- Develop test plans, execute test cases, document results, and support user acceptance testing.
- Participate in release and upgrade activities including regression testing, validation, and remediation.
- Provide knowledge transfer and mentorship to internal analysts and project stakeholders.
Requirements
- Epic Tapestry Claims certification (current, former, or NVT accepted).
- 3+ years of professional experience supporting Epic Tapestry Claims in a build/configuration role.
- Strong expertise with claims adjudication logic, benefits configuration, and provider contract setup.
- Solid understanding of managed care processes, regulatory compliance requirements, and industry-standard claims workflows.
- Proven ability to troubleshoot complex claims issues and partner with operational teams to resolve root causes.
- Excellent communication, analysis, documentation, and stakeholder-management skills.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingbenefit structurescontract configurationadjudication rulestroubleshootingtest planstest casesuser acceptance testingregression testingvalidation
Soft skills
communicationanalysisdocumentationstakeholder managementmentorship
Certifications
Epic Tapestry Claims certification