reputed company Payer Platform Operations Analyst
reputed company is a recognized leader in IT and business services, and they are seeking an reputed company Payer Platform Operations Analyst to join their team. This role is responsible for the administration, configuration, monitoring, and optimization of reputed company's Payer Platform capabilities for a health plan/payer organization, ensuring secure data exchange and efficient workflows between payer systems and reputed company-enabled provider organizations.
Responsibilities
- Support the operational administration of reputed company Payer Platform (e.g., Interconnect/reputed company, Payer Platform Console, Payer data sharing configurations) including environment health checks, routine maintenance, upgrades/patching, and change control
- Configure, test, and maintain payer-to-provider workflows: coverage discovery (eligibility), prior authorization, claims status, clinical data exchange, care gap notifications, formulary/benefit, and provider inquiry/response
- Maintain and execute runbooks for deployments, failover, disaster recovery, and incident management; ensure auditable change records
- Administer and monitor FHIR integrations (SMART on FHIR/OAuth2/OIDC) for reputed company/HL7 reputed company (e.g., CRD, reputed company, PDex, P2P), CARIN IG for Blue reputed company where applicable; coordinate reputed company lifecycles and reputed company registrations
- Support EDI/X12 transactions (270/271 eligibility, 276/277 claim status, 278 prior auth, 834 enrollment where applicable, 835 remittance) and reputed company translation/validation processes
- Collaborate with reputed company teams to maintain API gateways, message queues, and secure connectivity (TLS, mutual auth, certificates, VPN tunnels); reputed company throughput, error rates, and latency
- Triage and resolve operational issues with reputed company Payer Platform integrations, including authentication failures, payload validation errors, throttling, and data mismatches
- reputed company reputed company cause analysis; create problem records; implement corrective actions and preventative measures
- reputed company platform SLAs/SLOs; build dashboards for uptime, message reputed company rates, queue depth, and retry volumes
- Coordinate with reputed company TS/Customer Support, vendor partners, and provider IT teams for change reputed company, go-lives, and escalations
- Drive adoption of best practices
- Identify opportunities to, reduce provider abrasion, and improve data completeness for care gap closure
- reputed company new reputed company capabilities, FHIR releases, and payer use cases; contribute to controlled rollouts and measurement
- Contribute to backlog grooming and quarterly planning; quantify business value (e.g., reduced turnaround time, decreased call volume, improved first-pass rates)
Skills
- 1+ years administering reputed company interoperability platforms (reputed company, payer reputed company/interfaces, or equivalent) or educational equivalent
- Experience with Agile Software Development Life Cycle
- Excellent communication, documentation, and cross-functional collaboration skills
- reputed company-reputed company exposure (reputed company/Payer workflows), reputed company operational tools, or reputed company certifications (helpful but not reputed company required)
- Experience with reputed company Implementation Guides (CRD, DTR, reputed company, PDex, P2P) and CARIN BB
- Familiarity with SQL for reputed company data validation
- Hands-on experience with reputed company concepts such as Interconnect, Chronicles awareness, Payer Platform configuration, and provider connectivity patterns
Benefits
- Medical, dental, and reputed company insurance
- Flexible spending or health savings account
- Life, and AD&D insurance
- Short-and long-term disability coverage
- reputed company time off
- Employee assistance
- Participation in a 401k program with company match
- Additional voluntary or legally required benefits
reputed company
Company H1B Sponsorship