We are seeking a specialized Healthcare Business Configuration Analyst to serve as a Subject Matter Expert (SME) for our Managed Vision Care client portfolios. In this role, you won't just input data you will serve as the architect of our benefit structures, utilizing a blend of advanced system configuration tools and deep relational database analysis to ensure seamless, accurate claim adjudication.
If you have 5+ years of experience navigating core claims administration platforms, a mastery of the Facets system, and the SQL skills to pull and analyze data independently,
Required
Education: Associate degree or equivalent professional experience.
Core Claims Experience: Minimum of 5 years of hands-on experience working directly within a core healthcare claims administration system.
SQL Proficiency: Minimum of 2 years of experience writing SQL queries from scratch and exporting relational database tables into Excel for deep-dive analysis.
Analytical Mindset: Excellent independent problem-solving skills with the ability to manage multiple complex, high-priority assignments at once under strict SLA turnaround times.
Communication Skills: Strong interpersonal skills to effectively coordinate cross-functional activities and resolve production issues with diverse operational stakeholders.
3+ years of operational experience in the Healthcare or Managed Care industries.
Deep understanding of claim adjudication workflows, specifically regarding member and provider reimbursement structures.
Direct platform experience with the Cognizant Facets platform, specifically within Claims, Provider, Network, or Product Benefit Configuration modules.
Informational knowledge of Medicare and Medicaid program guidelines and regulations.
Duties; Build & Configure: Own the end-to-end structure and setup of managed vision care benefit plans in the Facets system, executing builds via both automated Product Key Sheet (PKS) matrices and precise manual configuration methods.
Analyze & Troubleshoot: Write complex SQL queries to extract data from database tables into Excel, proactively identifying, analyzing, and resolving system bottlenecks or logic mismatches.
Ensure Adjudication Accuracy: Safeguard data integrity across configuration tools to eliminate downstream errors for member and provider reimbursements.
Collaborate Cross-Functionally: Manage your production queue independently while maintaining strong, results-driven partnerships with Implementation Managers, Account Managers, and Claims Operations.
Drive Continuous Improvement: Recommend process and system enhancements to streamline builds, and support the management team with ongoing training activities and technical mentorship for junior team members.
