*Hi,*
*Please share only GC, GC EAD, USC candidate*
Please share your consultant resume at *manish.ku...@contech-it.com
*
*Title: System Analyst *
*Location: EDEN PRAIRIE, MN**Client: UHG*
*Job Duties and Description:*
Reminder- this role is NOT remote.
Cirrus is Health Plan in a Box offering end-to-end platform, designed to
perform all core health plan administrative functions.
*Entities:* Carriers, Networks, Provides, Member Groups, Members
*Entity Relationships:* Provider Contract, Network Contract, Member Group
Contract, Provider Affiliation to Network, Member Affiliation to Member
Group
*Configuration Modules:* Plan Design, Spending Account Design, Pricing
Configuration, Capitation Configuration, Premium Billing Configuration
*Business Events:* Claim Adjudication, Claim Pricing, Premium Billing,
Capitation Processing, Member Enrollment Processing
Adjudication and other business functions/events perform a direct read of
configuration rules in Cirrus
Cirrus offers multiple Product Support to Medical, dental, vision,
pharmacy, specialty carve-out plans. Aggregated multi-product plans (e.g.
combined medical and dental).
HMO/Gated, PPO, EPO, indemnity and multiple tier plans. Supports an
unlimited number of coverage tiers and network associations within a single
plan. Complex benefit leveling components within each coverage tier.
The Claims Trainer will participate in the development and effective
delivery of training programs across the organization. The primary focus of
this role is to plan, coordinate, facilitate, and deliver training sessions
that may include large group classroom or virtual session, 1:1 sessions as
needed, and train the trainer sessions as required.
Additionally, the Claims Trainer will need to keep abreast of various
training delivery techniques, business processes, products and systems that
may enhance the training experience. The role will also may entail
managing, implementing and evaluating of the newly developed training
programs to prepare high quality and highly competent staff for meaningful
contributions in the workplace.
This position will assist in the preparation of training related materials
and provide leadership within the classroom or virtual trainings and will
report on training metrics and generate training related metrics and
reports. There will be a minimum of 10-40% travel; potentially more.
*Primary Responsibilities:*
- This position is responsible for training on healthcare claims
processing that will includes end-to-end claims processing and adjudication
- Ensure that all aspects of delivering a seamless experience for class
participants are addressed, including such as scheduling, preparation,
audience registration, are addressed.
- Write scripts/talking points and supporting materials for learning
activities
- Provide leadership within the in-person or virtual classroom
environment
- Setup training scenarios within test applications to be used in classes
- Help to develop and update all training materials in conjunction with
the instructional designers; this includes existing job aids and manuals
with application changes and upgrades
- Monitor and suggest training program improvements for effectiveness
- Leverage creativity and utilize a wide variety of methods to present
training programs
- Work with team to coordinate training dates, location and other
preparations
- Work with team to facilitate project discussions and presentations
- Set appropriate expectations for all applicable stakeholders to ensure
ongoing support and achievement of learning objectives
- Ensure the logistics of the learning environment are completed and in
place (e.g., rosters, technology, room arrangements/configuration, learning
materials)
*Required Qualifications:*
- Bachelor's Degree or equivalent work experience
- MUST HAVE: Claims experience in a managed care setting (payer)
- MUST HAVE: Strong technical knowledge of HMO policies and regulations
- MUST HAVE : 3- 4 years Medical claims processing experience and a
solid understanding of industry standard methodology
- Expert level knowledge in the healthcare industry, end-to end claims
processing and adjudication
- Advanced experience with MS Word, Excel, and PowerPoint
- Ability to travel at least 10-40% of the time; potentially more
*Preferred Qualifications:*
- Must be well-organized and possess a high degree of attention to detail
- Ability to learn new product offering and functionality as software
updates are available
- Strong communication skills and be confident in presenting technical
information
- Ability to work independently with a high sense of urgency
- Knowledge of adult learning theory and principles
- Ability to prioritize/organize work to meet deadlines with multiple
projects
- Self-starter and ability to quickly learn