Consultant Healthcare Claims Configuration
8 - 10 years experience • Software
If you are an expert in healthcare Claims Adjudication and Administration, and enjoy building strong business relationships with clients, than this could be the right role for you. You will go into the field as part of a team to implement the Pega software solutions and configure healthcare claim adjudication and automation products. In doing so, you will greatly impact the business operations and bottom line of Pega’s clients. You will collaborate with Lead Business Architects to work through the software development lifecycle. You will also have the opportunity to influence product strategy.
In this role, you will:
- Provide expert services for the client and consulting team in healthcare claim (Medical, Dental, Vision, and Rx) processing and administration
- Represent Pega Healthcare as a domain expert through Pega sponsored initiatives like Trade Shows, Podcasts, Webinars and blogs.
- Collaborate cross-functionally with sales, alliances, corporate and field marketing, product development, and service delivery teams to deliver vertical plans, solution proposal campaigns and sales enablement.
- Serve as a role model for Pega values.
- Partner with multiple stakeholders to develop high quality deliverables across all phases of a project
- Leverage industry experience to consult and influence the client's direction
- Demonstrate commitment to and enthusiasm for customer success by ensuring the delivered product is fully-functioning, performs to business requirements defined and approved by the client.
- Support Account Executives, Engagement Leaders and Practice Leaders in the pursuit of new opportunities in solution conceptualization
- Explore various industry standard methodologies and communicate policies and procedures to clients, partners and teammates
- A rapidly growing yet well-established business
- The world’s most innovative organizations as reference-able clients
- Analyst acclaimed technology leadership in a massive emerging market
- The opportunity to make a tangible impact on the world’s market-leading organizations
- A collegial and friendly team environment
- Opportunities for growth and advancement as well as training to develop management and leadership skills
Qualifications will include:
- Deep experience with the planning and configuration of healthcare claim adjudication solutions (Medical, Dental, Vision, and Prescription Drug).
- Detailed knowledge of claim processing, that includes claim intake, member and provider eligibility, pricing configuration and provider agreements, claims business and clinical edits, and workflow management through provider payment.
- Strong client facing skills and demonstrated experience building business relationships.
- The ability to communicate clearly and effectively to all levels of an organization and work as part of a team
- Ability to explain to technology teams the business logic associated with complex claim adjudication scenarios such as coordination of benefits, provider capitation agreement, encounter data, timely filing and timely adjudication measurement requirements.
- Understanding of health reform mandates and their impact on claim adjudication configuration
- Bachelor’s degree.
- Experience working with diverse teams of business users in customer organizations on definition and implementation of business process changes.
- Experience partnering with business users, IT teams: quality assurance and production support groups.
- Solid understanding of the SDLC (Systems Development Life Cycle) and the requirement management lifecycle.
- Good presentation skills and experience presenting to small groups.
- Desire to learn Pega’s software products and learn aspects of the software development life cycle.
- Pega training: Completion of training in Pega 7, achieve Certified Pega Business Architect designation, and successfully go through Pega Enablement.
- More than 75% travel.
Pegasystems Inc. is a leader in software that streamlines business and enhances customer engagement in Global 3000 organizations. With more than 30years of proven innovation, Pega seamlessly connects organizations with their customers across multiple channels in real time using market-leading CRM, advanced artificial intelligence, and powerful automation. Pega’s adaptive, cloud-architected applications – built on its unified Pega® Platform – empower people with comprehensive visual tools to easily extend and change applications to meet strategic business needs.
As an Equal Opportunity and Affirmative Action employer, Pegasystems Inc. will not discriminate in its employment practices due to an applicant’s race, color, religion, sex, national origin, age, genetic information, sexual orientation, gender identity, veteran or disability status, or any other category protected by law