Senior Claims Testing Analyst
Full-time
8 months ago
Employment Information
Ready to help us transform healthcare? Bring your true colors to blue.
The Senior Claims Testing Analyst is responsible for reviewing business requirements,
developing, and executing comprehensive test plans, analysis of reporting, performing claims quality
review, mentoring associates and ensuring department goals are met in a high-quality manner within
established time frames
Key Accountabilities:
Define, develop, and implement test plans and test cases to validate new coding logic or system changes for complex business requirements
Work closely with IT on testing automation and consistent improvement opportunities for enhanced testing output
Present test plans to internal partners
Ensure identified compliance risks are reported to leadership when discovered
Keen attention to detail and documentation with the ability to independently prioritize deliverables
Support monthly team quality review and contribute to internal departmental process improvement opportunities
Analyze and troubleshoot system issues, report defects, and develop recommendations for improvement
Champion on-going assessments and analysis of test results, identify, and implement opportunities to improve the effectiveness of testing
Lead special projects and assignments as identified by Leader
Ensure internal Quality and Audit controls are followed including traceability of testing efforts
Lead implementing of innovative initiatives to streamline processes, including automation possibilities.
Develop and maintain technical documentation and user manuals as processes change.
Participate in requirements walk-throughs and make recommendations that will satisfy Medicare Markets business processes
Demonstrated flexibility and willingness to change, as the business needs change within the organization.
Provide training & mentoring to junior associates
Serve as a Medicare Advantage SME of the HealthEdge Source pricing platform
Prepare and deliver communications, reports and supporting documentation to directors and managers related to project assignments.
Key Competencies:
Excellent interpersonal, verbal, and written communication skills; able to effectively communicate to all levels of management
Self-starter with demonstrated analytical skills and attention to detail
Self-motivated individual with excellent organizational abilities and the flexibility to handle multiple priorities and meet aggressive deadlines
Demonstrates action orientation, accountability and persevere through challenges to meet goals
Collaborating toward shared goals, works with leaders to evaluate options by considering implications, risks, feasibility, and consequences
Display commitment to teamwork
Ability and drive to present change ideas across a broader partnership team, including customers and delivery partners
Ability to drive collaboration across the business to get things done.
Experience and Education:
Bachelor’s degree or equivalent work experience
3+ years of testing experience required
3+ years of business and/or systems area specific knowledge
Strong knowledge of claims, medical coding/billing, and healthcare systems
Previous testing experience required including direct experience with test plan development
Demonstrated proficiency in Microsoft software: Word, Excel, Access, and Outlook
Advance knowledge of Jira
Strong knowledge of Data warehouse
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Hingham Time Type Full time
Salary Range: $90,500.00 - $113,740.00
The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.
This job is also eligible for variable pay.
We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our " How We Work " Page.
The Senior Claims Testing Analyst is responsible for reviewing business requirements,
developing, and executing comprehensive test plans, analysis of reporting, performing claims quality
review, mentoring associates and ensuring department goals are met in a high-quality manner within
established time frames
Key Accountabilities:
Define, develop, and implement test plans and test cases to validate new coding logic or system changes for complex business requirements
Work closely with IT on testing automation and consistent improvement opportunities for enhanced testing output
Present test plans to internal partners
Ensure identified compliance risks are reported to leadership when discovered
Keen attention to detail and documentation with the ability to independently prioritize deliverables
Support monthly team quality review and contribute to internal departmental process improvement opportunities
Analyze and troubleshoot system issues, report defects, and develop recommendations for improvement
Champion on-going assessments and analysis of test results, identify, and implement opportunities to improve the effectiveness of testing
Lead special projects and assignments as identified by Leader
Ensure internal Quality and Audit controls are followed including traceability of testing efforts
Lead implementing of innovative initiatives to streamline processes, including automation possibilities.
Develop and maintain technical documentation and user manuals as processes change.
Participate in requirements walk-throughs and make recommendations that will satisfy Medicare Markets business processes
Demonstrated flexibility and willingness to change, as the business needs change within the organization.
Provide training & mentoring to junior associates
Serve as a Medicare Advantage SME of the HealthEdge Source pricing platform
Prepare and deliver communications, reports and supporting documentation to directors and managers related to project assignments.
Key Competencies:
Excellent interpersonal, verbal, and written communication skills; able to effectively communicate to all levels of management
Self-starter with demonstrated analytical skills and attention to detail
Self-motivated individual with excellent organizational abilities and the flexibility to handle multiple priorities and meet aggressive deadlines
Demonstrates action orientation, accountability and persevere through challenges to meet goals
Collaborating toward shared goals, works with leaders to evaluate options by considering implications, risks, feasibility, and consequences
Display commitment to teamwork
Ability and drive to present change ideas across a broader partnership team, including customers and delivery partners
Ability to drive collaboration across the business to get things done.
Experience and Education:
Bachelor’s degree or equivalent work experience
3+ years of testing experience required
3+ years of business and/or systems area specific knowledge
Strong knowledge of claims, medical coding/billing, and healthcare systems
Previous testing experience required including direct experience with test plan development
Demonstrated proficiency in Microsoft software: Word, Excel, Access, and Outlook
Advance knowledge of Jira
Strong knowledge of Data warehouse
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Hingham Time Type Full time
Salary Range: $90,500.00 - $113,740.00
The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.
This job is also eligible for variable pay.
We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our " How We Work " Page.
Share this
