Data Analyst

Data Analytics Specialist

Only considering candidates with strong Data Analytics, SQL, Healthcare background with claims adjudication and hands-on experience working on 837/835 files.

Client manager Notes: Absolute Must Haves

• Detailed knowledge of 837/835 EDI formats including all segments and loops.
• Ability to manipulate 837/835 EDI /XML files to generate a wide variety of valid claims.
• Experience and in-depth knowledge of Claim Adjudication process.
• Experience with Dynatrace Monitoring a plus.

Responsibilities:

• Perform initial triage and full incident life cycle monitoring in support of FEP Bridge Tenant Plans. This position requires technical and analytical skills with a focus on incident definition, isolation, and resolution. It requires deep knowledge of EDI 837 Claims analysis, 999 errors and SQL queries.
• Work with various members of the FEP TOS team to provide Tier 1 technical support to tenant Bridge plans. Tier 1 support involves the initial triaging of reported incidents with the FEP Bridge applications with a focus on data collection and prior incident pattern analysis.
• Work closely with FEP Bridge Plan Consultants to ensure smooth communication and prompt follow-up on logged incidents with the applications.
• Provide some basic technical support for tenant plans, running queries, and making recommendations on changes to the tenant plans interfaces to improve the overall customer experience.
• Create and run performance monitoring reports for end customers including SLA tracking reports.
• Manipulation of 837/835 EDI /XML files to generate a wide variety of valid claims.
• Write complex SQL queries for retrieval of required data from a multi-database environment. Strong knowledge of Oracle database required.
• Accountable for specific deliverables as defined by the Plan Consultants, and FEP TOS leadership.
• Document incident resolutions, escalations, and closures within the CareFirst Incident tracking tool.
• Document system monitoring design, implementation, as well as SOPs for various support teams in FEP TOS.

Additional Skills:

• This position requires a BA/BS in computer science or equivalent experience, and more than 2 years professional software support experience with an emphasis on incident resolution.
• Specific requirements include, but not limited to:
• Detailed knowledge of 837/835 EDI formats including all segments and loops.
• Ability to manipulate 837/835 EDI /XML files to generate a wide variety of valid claims.
• Experience and in-depth knowledge of Claim Adjudication process.
• Experience with Dynatrace Monitoring a plus.
• Some exposure to Object Oriented languages a plus.
• Experience with SQL queries.
• Excellent communication and teamwork skills.