UNITE HERE HEALTH

  • Sr. Technical Claims Adjudicator

    Job Locations US-IL-Aurora
    Posted Date 3 weeks ago(4/4/2018 9:41 AM)
    ID
    2018-1438
    # of Openings
    1
    Category
    Medical Claims
    Company
    UNITE HERE HEALTH
  • Overview

    betterworkplaceuhh

     

     

    Looking for a way to influence the health and healthcare of many?

     

    If so, we’d love to hear from you! Our mission-driven organization is focused on theTriple Aim - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

     

    UNITE HERE HEALTH serves 100,000+ workers and 220,000 covered lives in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

     

     

    Key Attributes:

     

    • Integrity – Must be trustworthy and principled when faced with complex situations
    • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required
    • Communication – Ability to generate concise, compelling, objective and data-driven reports
    • Teamwork – Working well with others is required in the Fund’s collaborative environment
    • Diversity – Must be capable of working in a culturally diverse environment
    • Continuous Learning – Must be open to learning and skill development.  As the Fund’s needs evolve, must be proactive about developing new areas of expertise
    • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

     

     

    Responsibilities

    The purpose of this position is to support the department by the claims system and building medical, dental and vision plans.  This position will evaluate the effectiveness of how the claims processing system is being utilized by the department.  This position will also maximize the claims system capabilities by identifying and solving system related issues and by recommending process improvements to the Claims Department Management Team.

     

    • Evaluates system performance through feature and function testing
    • Develops, documents and executes test cases
    • Creates and maintains testing specifications
    • Calculates, summarizes and communicates testing results
    • Evaluates system documentation for the purposes of creating targeted test cases
    • Identifies, triages and documents system plan, feature interaction and programming defects
    • Evaluates plan builds for accuracy and automation
    • Provides written feedback detailing errors and expected system behavior
    • Evaluates system file and data consumption
    • Assesses testing results from business/User Acceptance Testing (UAT) testers and provide relevant feedback and/or correction
    • Provides technical support to business users
    • Performs other duties as assigned within the scope of responsibilities and requirements of the job
    • Performs Essential Job Functions and Duties with or without reasonable accommodation

    Qualifications

    • High School Diploma or GED
    • College degree preferred
    • 1 ~ 2 years of direct experience minimum
    • Working knowledge and experience in plan building and claim testing: Preferred
    • Experience with Javelina claim adjudication system required
    • Knowledge of medical, dental, vision, life & LOT claims required
    • Knowledge and experience in medical terminology including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-9 10 required
    • Knowledge of major medical benefit application and plan building features required

    Ability to:

    • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
    • Intermediate level Microsoft Excel skills
    • Problem solving, multi-tasking, analytical, and decision making skills
    • Attention to detail, time management, organizational, and investigative skills
    • Communication skills (written and verbal)
    • Ability to communicate system functions and requirements to developers, vendors and business users
    • Ability to create scenarios/situations for testing purposes and document testing outcomes

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