Job Description

Position Title: Certified Claims OR Certified Benefits consultant. (1 opening for each)

Location: Remote

Start Date: ASAP

End Date: At least on contract until August 2026 Go-Live, likely longer

Hours: 8-5 EST

Duties:

• Support build and configuration of claims, benefits, prior authorization, and referral workflows in Epic Tapestry.
• Assist in developing, executing, and documenting UAT scripts, ensuring business requirements are met and system functionality aligns with plan policies.
• Validate benefit setup, contract loads, fee schedules, PA rules, and claims adjudication logic.
• Collaborate with business analysts, project managers, IT, and operational SMEs to troubleshoot and resolve system issues during build and testing.
• Participate in issue tracking, root cause analysis, and resolution using tools like ServiceNow, ChangeGear, or similar.
• Provide guidance and expertise on Medicaid, Medicare, and Commercial health plan rules as they relate to claims and benefits processing.
• Contribute to process documentation, training materials, and knowledge transfer for the operational teams.
• Ensure regulatory compliance and adherence to project governance standards throughout build and UAT activities.

Job Tags

Similar Jobs