Medical Claims Specialist  

The Claims Solution Consultant (CSC) is responsible for understanding their assigned clients claim systems and payment policies so they may document requirements for implementing services and rule engine components either during the initial and/or subsequent phase of implementation. They are also responsible for supporting their clients during maintenance periods which may require researching issues, analyzing software behavior and remediating defects.

The Claims Solution Consultant must be an active consultative client facing participant within the assigned team structure to ensure quality client deliveries within targeted timeframes based upon work effort and allocation.

Job Responsibilities:

• Effectively work as a ClaimsXten rules development subject matter expert on client implementations. This will require working consultatively with the client and documenting granular requirements for signature.
• Address all assigned client issues & requests that are generated through the McKesson Services Support Center.
• Effectively participate on internal or external ClaimsXten Service Delivery Team meetings and initiatives. Conduct training as needed.
• Provide forecasting, supply requested metrics and attend or potentially lead team meetings.

• Bachelor’s Degree in Computer Science, Healthcare Related Field, or equivalent business experience
• 3+years of experience in health care combining first hand payor and consulting experience
• Medical claims experience within payor environment ideal.
• SDLC exposure needed.
• Understands payor environments and claims management
• High level understanding of different customer segments (national, strategic and/or specialized business)
• High level understanding of claim architecture, infrastructure, and multiple platforms
• Discusses customer issues (pains and trends) confidently with customers
• Understands medical terminology, healthcare industry terminology and medical coding terminology
• Deliver presentations effectively to the customer
• Able to understand and articulate ClaimsXten rules development
• Conducts customer meetings/trainings efficiently and effectively
• Proficient in using MS Word, PowerPoint, Excel and Visio
• Willing to work in BGC, Taguig