Experian

Company Description

Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to realize their financial goals and help them save time and money.

We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more industry segments.

We invest in people and new advanced technologies to unlock the power of data. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 22,500 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.

Job Description

Business Analyst, Claims Status is responsible for Experian Health claims status solutions by representing the product to the outside world and representing customers' interests internally. The Business Analyst Support, Claim Status reviews, manages, and resolves claim status support tickets and open items for Claim Status clients as well as internal Claim Status users as necessary. The Business Analyst Support, Claim Status creates web capture outline documents and aide in the testing of new web capture builds and monitoring of the current web capture processes for all payers associated with the claim status process.

Communication with external and internal clients to the claim status product is required.

You will report to ECS - Enhanced Claim Status Product.

ESSENTIAL FUNCTIONS:

• Review and monitor of ECS – Claim Status responses on a scheduled timeline to assure health of the payer(s) and transactions responses.
• Review and monitor of the EDI – Claim Status responses on a scheduled timeline to assure health of the payer(s) and transaction responses.
• Assists and participates in the management and coordination of new payer builds by assuring complete data gathering for development work; claim examples, remit data and claim confirmation information as needed for successful new payer build for both EDI requests and ECS claim status enhanced addendum data.
• Assist as needed with new payer build review and resource to the development team during the payer build through testing and production validation.
• Manage new and existing payer data notation documenting enhanced data available by payer response. This document will be maintained for usage by the implementation team to share with the clients as to what value add data is available by payer.
• Assist and participation in scheduled client review(s) to create product ROI.
• Assist and participate in payer support review, research and resolution of SalesForce cases needing tier 2 and higher support.
• Assists and participates in management of third-party vendor procedures as it relates to client, payer credentials and scripting.
• Assists and participates in management and monitoring of third-party vendor transaction health, accuracy of request files and response files, along with delayed response activity.

Qualifications

EDUCATION: Bachelor's degree or greater in related field, or equivalent education and experience.

Experience:

• 3 years' experience working in the healthcare industry.
• Familiarity with Medicare and commercial insurance policies.
• Skills in database platforms (Excel (can maintain complex spreadsheets), Access, etc.).
• Understanding of X12 276/277 claim status response(s)
• Understanding of X12 277CA – claim acknowledgement, 837, 835 and 999 transaction sets.

Additional Information

This is a permanent home-based role in Costa Rica. No Visa sponsorship or relocation available.**

Our benefits include: Medical, life and dental insurance, Asociación Solidarista, International Share Save Plan, Flex Work/Work from home, Paid time off, Annual Performance Bonus, Education Reimbursement, Family Bonding, Bereavement Leave, Referral Program, and more.

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Our goal is to create a successful, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is important to our purpose of creating a better tomorrow. We value the uniqueness and want you to bring your whole, authentic self to work. For us, this is The Power of YOU and it ensures that we live what we believe.

Experian Careers - Creating a better tomorrow together

Find out what its like to work for Experian by clicking here

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