sr adjudication and configuration analyst.

The Sr Adjudication and Configuration Analyst provides Liviniti employees and customers with comprehensive knowledge of the claim processing system(s). This includes answering questions and assisting with problem resolution, managing projects, assisting team members, and making updates and changes within the claims processors as well as auditing corrections. This role is contract-to-hire and fully remote.

salary: $20 - $40 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

• Adjudicates information on multiple software platforms and claims processors.  
• Enforces procedures that are put in place by the Sr Manager - Benefit Design, Configuration, and
• Adjudication, Sr Director – Claims Configuration, Adjudication, and Operations, and VP of Operations. 
• Identifies and corrects Benefit Design errors within the claims processor based on client documentation.
• Facilitates benefit designs for new clients within the claims processor based off of documentation.
• Communicates with the Implementation team to discuss and/or ask questions regarding benefit designs for new clients.
• Communicates with the EDI team to discuss and/or ask questions regarding various data files.
• Communicates with the Clinical team to discuss and/or ask questions regarding clinical edits that are active for current clients.
• Works in conjunction with the Clinical team to input information into the claims processor and makes updates based on extensive testing to ensure the clinical request is to appropriate specifications.
• Communicates with the Account Management team to facilitate benefit design updates and obtain appropriate documentation for current clients.
• Assists internal departments with troubleshooting and resolving issues within our claims processor, when appropriate.

Skills

Benefits Administration

Claims Processing (2 years of experience is preferred)

Claims

Customer support

Data Processor

Data Entry

Audit - Internal

HIPAA

Quality Analysis

Excel Macros (2 years of experience is preferred)

Excel Pivot Tables (2 years of experience is preferred)

Pharmaceutical (2 years of experience is preferred)

SQL (2 years of experience is preferred)

Qualifications

Years of experience: 4 years

Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.