Provides support to Claims Operations by investigating and resolving systemic issues relative to claims processing system files and interfaces for membership, authorizations, providers, pricing, reporting and financial. Assist in testing and documenting of account specific benefits to ensure accurate claims adjudication. The position assists in ensuring system performance and resolution of system problems that may impede claims processing.
Assists in testing of system enhancements and modifications.
Assists with development of system enhancements and analysis of system performance.
Performs root cause analysis and resolve system problems identified by claims examiners or other internal staff.
Assists in testing and documenting of account specific benefits and system enhancements.
Performs audits of each changed or newly configured plan to ensure that benefits are added accurately and consistently across the various plans.
Analyzes structure to identify any issues or concerns with the benefit structure provided.
Interfaces with other departments to obtain information to resolve issues related to system enhancements and plan configuration.
Maintains working knowledge of multiple testing environments, multiple accounts and multiple job functions.
Provides backup support to other team/group members in the performance of job duties assigned.
Other Job Requirements
Responsibilities
5+ years claims processing experience.Knowledge of ICD-9 and CPT coding terminology.Knowledge and understanding of database management and documentation.
General Job Information
Title
Claims System Specialist II
Grade
19
Work Experience - Required
Claims
Work Experience - Preferred
Education - Required
Education - Preferred
Bachelors
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .
Warning: Employment Scam
It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. -Interviews- are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.
Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911
