Offer summary
Qualifications:
7 years of relevant healthcare experience, Experience in health plan operations and technology, Data analysis skills from source systems, Knowledge of state claims processing rules, Master's in Healthcare or related fields preferred.
Key responsabilities:
- Oversee TPA processing for member data
- Validate and approve claims and member test cases
- Coordinate development of operational reports
- Resolve processing issues with the TPA
- Audit claims and track implementation milestones