Provides support to Claims Operations by investigating and resolving systemic issues relative to claims processing system files and interfaces for membership, authorizations, providers, pricing, reporting and financial. Assist in testing and documenting of account specific benefits to ensure accurate claims adjudication. The position assists in ensuring system performance and resolution of system problems that may impede claims processing.

• Assists in testing of system enhancements and modifications.


• Assists with development of system enhancements and analysis of system performance.


• Performs root cause analysis and resolve system problems identified by claims examiners or other internal staff.


• Assists in testing and documenting of account specific benefits and system enhancements.


• Performs audits of each changed or newly configured plan to ensure that benefits are added accurately and consistently across the various plans.


• Analyzes structure to identify any issues or concerns with the benefit structure provided.


• Interfaces with other departments to obtain information to resolve issues related to system enhancements and plan configuration.


• Maintains working knowledge of multiple testing environments, multiple accounts and multiple job functions.


• Provides backup support to other team/group members in the performance of job duties assigned.

Responsibilities
Knowledge of ICD-9 and CPT coding terminology.
Knowledge and understanding of database management and documentation.
2+ years of claims processing experience.

General Job Information

Title
Claims Systems Specialist I

Grade
20

Work Experience - Required
Claims

Work Experience - Preferred

Education - Required

Education - Preferred
Bachelor's

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:
$41,505
Salary Maximum:
$62,255

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.