Claims Business Process Consultant

Primary Responsibilities:

• Responsible for UAT (User Acceptance Testing) test plan preparation and test execution of new product delivery initiative(s), crossing multiple applications, following Agile software development methodology
• Review product features and user stories to understand functional requirements and constraints (i.e. current and future state analysis)
• Develop test plans and scenarios that model business processes using capabilities, features, user stories, business process documents, system requirements, technical specifications, and Medicare/CMS policies
• Develop and maintain data requirements needed to meet all testing objectives (i.e. prepare group, member, cost containment and claim data within test environments)
• Research, identify and obtain data needed for claim testing (i.e. verify pricing, applicable benefits, etc.)
• Validate all functions perform according to the relevant acceptance criteria outlined in the capability, feature and user stories
• Provide test status updates during daily standup scrum team, product or project team meetings and defect calls
• Present test plans and results observed during test execution/product demos to business and technology stakeholders (i.e. create and deliver results presentations)
• Report, prioritize and track all defects to resolution; collaborate with scrum teams as needed
• Meet process targets and achieve test execution goals; ensure the objectives of each test phase are met
• Inform of any obstacles putting UAT progress at risk, in a timely manner, and contribute to option analysis conversations
• Maintain a working knowledge of integrated systems that support the claims product domain and surrounding systems
• Maintain working knowledge of integrated systems that support COSMOS/CPA
• Develop and maintain working relationships with individuals across a variety of functional areas (i.e. Business Owners, Product Owners, Technology, etc.)
• Facilitate or assist with group meetings (provide agendas and follow up with meeting minutes, as appropriate)
• Must have the ability to quickly react &/or adapt to any change in direction based on project needs (i.e. must stay agile)
• Serve as a dependable and reliable resource for others
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• 3+ years as a COSMOS Claim Processor/Claim Subject Matter Expert (SME) or similar role processing hospital and physician claims within COSMOS/CPW or CPA applications
• 3+ years of relevant experience within medical claims and/or payment operations
• 3+ years experience/knowledge of Medicare/CMS policies
• 1+ years experience with Medicare and Retirement line of business
• 1+ years experience User Acceptance Testing, End to End Testing or System Integration Testing experience
• Experience with creating and presenting PowerPoint presentations at different levels of the organization
• Experience with integrated claim payment systems (Claims Highway, CES, NDB, Payment Engine, etc.)
• Experience with Rally Software
• Intermediate level use of Microsoft Office products: Microsoft Word (create & edit), Microsoft Excel (create, edit, formulas & etc.), and Microsoft PowerPoint (create, edit & design)
• Understanding of claims processing including benefit structure, guidelines/reimbursement policies, claim adjudicated and industry terminology

Preferred Qualifications:

• Ability to confidently communicate and/or present complex and technical issues to diverse audiences (verbal/written)
• Knowledge of testing practices and Agile software development methodology