Supervisor – Configuration
# of years of required experience:
> 7 years
Shift position will be required to work (if applicable):
Please specify shift time
Max until 1:30 am IST (Based on client request If Any)
It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index, was named on the Best Companies for Women to Advance List 2020 by Parity.org, and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
We are seeking a Grievance and Appeals Coordinator to be a key member of the team. The Grievance and Appeals Coordinator is responsible for receiving, investigating, and resolving member administrative appeals, grievances and provider administrative appeals and supporting the clinical team with clinical appeals. All tasks will be in compliance with regulatory and accrediting agency standards
The person in this role is responsible for providing business support and analysis, understanding and documenting business requirements, facilitating the design of business requirements in system configuration that support the processing of claim and enrollment transactions within the core processing system. The person in this role may be responsible for evaluating and optimizing system configuration and/or integration. The person in this role will be the primary liaison between the technical teams and his/her respective business team(s). As the liaison, the person in this role will assist with gathering business requirements, documenting and optimizing business processes, advising on design options, assisting in documenting technical specifications, assist with unit and integrated testing of technical components
- Understands and/or learns the client’s business requirements, the impact of the new solution(s) on business processes, and translating that into detailed configuration requirements
- Develops detailed business requirements documenting the needs of the client department/agency
- Works to optimize business performance by recommending balanced approaches to configuration/system design and maintenance
- Facilitates system/configuration design sessions, crafts agendas and takes meeting minutes as necessary
- Validates system/configuration and documents issues
- Creates mapping documents and handles loading configuration into the core system
- Assists with development of business requirements and technical design for reports, letters, conversions, interfaces, extracts and file inputs
- Executes system tests (unit, integration, regression), analyzes and reports defects
- Documents, with client, vendor anomalies and submits them for review
- Maintains business documentation
- Facilitates and/or participates in the business process alignment sessions
- Provides support for training curriculum development
- Performs data analysis using database query tools
- Identifies risk and/or issues and escalates them appropriately
- Assists the Project Manager with planning and development of the system configuration and other business activities associated with the project schedule
- Identifies change requests and presents change control documentation for the client to submit for consideration
- Maintains a favorable working relationship with all project stakeholders to foster and promote a cooperative and harmonious working climate which will be conducive to maximum employee morale, productivity, and efficiency/effectiveness
- Keep immediate supervisor promptly and fully informed of all problems or unusual matters of significance and takes prompt corrective action where necessary or suggests alternative courses of action
- Participate in strategic and Operational related discussion.
- Create and develop talent within the team. Create trustworthy environment.
- Develop and mentor junior staff individuals
- Must have experience working on at least one (1) enterprise-wide system implementation (from start to finish)
- Solid analytical skills with ability to compile data from many sources and formulate plans and recommendations
- Excellent data manipulation, communication, analytical and statistical skills are required
- Must be comfortable SQL, MS Excel, MS Access, MS Word, MS Visio and MS PowerPoint
- Must have excellent time management and organizational skills with the ability to handle multiple tasks in a timely and accurate manner
- Ability to work under pressure, adhere to deadlines and know when to escalate information/issues
- Must have a high level of self-motivation and with little guidance/supervision
- Must be able to work both independently as well as a team participant
- Must have outstanding verbal and written communications skills with the ability to communicate clearly to all levels of an organization
- Must have strong interpersonal skills
- Experience with public and private exchanges
- Experience executing user acceptance testing and triaging test issues
- Prior class room or on-the-job training experience
- Experience mapping business processes
- Prior experience working with other ANSI x12 EDI standards for health care.
- Education Requirements: Bachelor’s Degree or equivalent work experience
- Knowledge of medical claims adjudication and editing
- Prior experience with Facets/RIMS, CSC or DST
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position primarily works in a climate controlled based setting. The noise level and the work environment are moderately quiet. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines
Include the physical demands of the job, including bending, sitting, lifting and driving. For example, while performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
Why Join Evolent?
Named among Forbes’ 2014 America’s Most Promising Companies and Glassdoor’s 2015 Best Places to Work, Evolent provides an opportunity to work with top talent in an organization committed to career development. While we come from a variety of backgrounds, we pursue a singular mission: to change the health of the nation by changing the way health care is delivered