Job description
Senior Applications Analyst – TPA Systems & Claims Processing
WelbeHealth is a value-based healthcare organization that’s transforming the future of senior care by providing an all-inclusive care option to our most vulnerable senior population.
The Senior Applications Analyst oversees the implementation and maintenance of WelbeHealth’s core and emerging technologies, including but not limited to, TPA, EMR, CRM, and home-based technologies and initiatives. The Senior Applications Analyst will design and evaluate new technologies, proactively diagnose and resolve problems, provide end user assistance, support strategy, complete table creation and configuration, and keep our enterprise technologies up to date as per the guidance and priorities of the Director or VP, IT Applications. This role will directly improve how efficiently we process claims, pay providers, and support scalable, tech-enabled health plan operations.
Essential Job Duties:
- Work independently to research, define, plan, and implement new TPA and claims processing system, supporting payer-side workflows including benefits, eligibility, prior authorization, and provider payments
- Configure and maintain adjudication logic, provider contract terms, and fee schedules within the TPA platform to ensure accurate claims processing, payment and encounter submissions
- Ensure TPA (Quick Cap) and integrated applications align with business requirements and systems goals, meet end-user needs, and identify and solve systems problems, as well as ensure data accuracy across claims, eligibility, and provider files to support efficient processing and reduce rework
- Oversee product updates for business applications, feature customization and improvement, maintenance, support, troubleshooting, and customer service
- Lead configuration, planning, and implementation of WelbeHealth’s business applications needs for new market entry (launch)
- Collaborate with the Training team to ensure new technologies and updates are included in training materials and curricula
- Perform workflow assessments, design workflows to match business requirements, and provide trainings and remote support on core technologies when needed, as well as assess existing business applications used in operations and identify opportunities for increasing value creation and developing process improvement plans accordingly
Job Requirements:
- Bachelor’s degree in relevant field; master’s degree preferred
- Minimum of five (5) years of experience with healthcare applications and technologies including:
- Minimum of five (5) years of experience managing claims processing system functionality (e.g., design, configuration, testing, optimization, and support) in a healthcare payer, TPA, or claim delegated risk environment
- Two (2) years of CRM or Care Management application experience preferred
- Advanced Microsoft Excel and PowerPoint skills required; strong data analytics and visualization skills required; PowerBI a plus
- Minimum of three (3) years of experience in a healthcare delivery environment
- Minimum of three (3) years of experience in technology solutions value creation such as in a product management, consulting, or business analysis role in a data-driven, fast-paced, high-growth setting
Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
- BENEFITS: Health Coverage on Day 1, Paid Parental Leave, 401K Match.
- PERKS: 17 days of paid time off in year one, 12 company holidays and 6 sick days
- GROWTH: Career path advancement and leadership opportunities
Salary/Wage base range for this role is $47.74 - $63.02 hourly + Bonus + Equity. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.
Compensation
$47.74—$63.02 USD
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
Our Commitment to Diversity, Equity and Inclusion
At WelbeHealth, we embrace and cherish the diversity of our team members, and we’re committed to building a culture of inclusion and belonging. We’re proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Beware of Scams
Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [email protected]
