Claims System Specialist II - R00000047655 DESCRIPTION/RESPONSIBILITIES: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 RequirementsResponsibilities* 5+ years claims processing experience.* Knowledge of ICD-9 and CPT coding terminology.* Knowledge and understanding of database management and documentation. General Job Information TitleClaims System Specialist II Grade19 Work Experience - RequiredClaims Work Experience - Preferred Education - Required Education - PreferredBachelors 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. Equal Opportunity Employer-minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
