• Requirements gathering analysis with Client
• Creation of detailed business design documents
• Walk-thru design documents with Client and obtain sign-off
• Create detailed test plans
• Execute test plans, report issues and retest
• Sign off on system readiness for Client delivery
• Assist Client with system set-up and business practice optimization
• Conduct pre-sales requirement studies for prospective customers
• Respond to Requests for Proposals from prospective customers
• Prepare and conduct system demonstrations
• Prepare training materials and conduct business user training
Pre-Requisites
Education:
• Four year College degree required
• Health industry certifications, such as HIAA or International Claims Association, desirable
Work Experience:
;
• Minimum of three – five years experience in health insurance environment:
o Heath insurance carrier
o Software company supporting health related products
o Software company supporting provider network products
Industry Knowledge:
• Health insurance background is essential:
o Understanding of U.S. health insurance delivery system
o Regulatory requirements
o Policy Administration:
Billing methods
Payment options
Commissions
Group Set Up
New Business Enrollment
Employee and Dependent Maintenance
Customer Service and Inquiry
Statistical Reporting
o Claims Administration:
Provider Maintenance
• Demographics
• Provider Network Arrangements
Benefit Provisions
Pricing Schedules
Claim Adjudication
• Electronic claim receipt and payment
• Paper claim receipt and payment
Checks/Explanations of Benefits
Claim Adjustments
Claim Inquiry
Statistical Reporting
Personal Skills:
• Strong Analytical Ability
• Excellent verbal and written communication skills
• Ability to work in team environment under tight deadlines and shifting priorities
• Strong organizational skills; ability to multi-task
• Self starter; responsible for own actions and results
Required
• Bachelor's Degree
• At least 5 years experience in Core insurance consulting
• English: Fluent
• Chinese simplified: Fluent
Additional information
Pre-Requisites
Education:
• Four year College degree required
• Health industry certifications, such as HIAA or International Claims Association, desirable
Work Experience:
;
• Minimum of three – five years experience in health insurance environment:
o Heath insurance carrier
o Software company supporting health related products
o Software company supporting provider network products
Industry Knowledge:
• Health insurance background is essential:
o Understanding of U.S. health insurance delivery system
o Regulatory requirements
o Policy Administration:
Billing methods
