รายละเอียดงาน
• Requirement Gathering & Documentation: Work with stakeholders to gather and
document business requirements for health insurance claims processing.
• Claims Process Optimization: Analyze existing health claims workflows, identifying
bottlenecks, inefficiencies, and areas for improvement. Propose solutions to streamline
claims adjudication, payment, and denial management processes.
• Data Analysis: Extract and analyze claims data to uncover trends, improve accuracy,
and optimize decision-making. Generate reports and dashboards to provide insights to
senior management on claims performance.
• System Implementation & Support: Work closely with the IT team to implement claims
processing systems, enhancements, or new software platforms. Validate the system
functionality aligns with business needs and ensure smooth integration.
• Testing & Quality Assurance: Assist in developing and executing test plans to ensure
that claims processing systems meet functional and business requirements. Validate
accuracy in claims adjudication, pricing, and payment.
• Stakeholder Collaboration: Serve as a bridge between business teams and technical
teams to ensure that system solutions are effectively aligned with business needs.
Regularly interact with medical billing teams, claims processors, and third-party
administrators.