We are seeking a motivated and detail-oriented individual to join our team as a Sr Capability Analyst. This position offers the opportunity to lead and support critical claim projects in a dynamic work environment.

Responsibilities

• Lead initiatives to mitigate known claim issues and resolve escalations effectively.
• Gather and document claims processing requirements in alignment with business partner needs.
• Evaluate and recommend solutions that minimize costs while meeting operational requirements.
• Communicate testing scenarios and provide feedback on execution gaps.
• Draft policies and procedures for claim processing based on state partner requests.
• Train operations teams on new processes and system capabilities.
• Conduct audits using SQL reports to validate claims processing outcomes.

Skills

• Proficient in Microsoft Office Suite, particularly Excel, Word, and Visio.
• 3+ years of experience with CSP Facets Claims Platform.
• Strong analytical and problem-solving skills in a customer-focused environment.
• Moderate proficiency in computer applications and the ability to learn new systems quickly.

Preferred Skills

• Expertise in Medicaid and DSNP Claims Domain.
• Experience capturing requirements in a healthcare setting.
• Knowledge of claims processing best practices.
• Associate’s Degree or higher in a related field.

We believe in fostering a diverse, equitable, and inclusive workplace where every team member's contributions are valued. We encourage individuals from all backgrounds to apply and join us in creating a supportive environment.

Once you apply for this position, you may receive a phone call, SMS or email at the time of application from our Virtual AI Recruiter, Alex, to conduct an initial interview.