Engineer II, Quality Claims — Emerson, Mandaluyong Hybrid
EmersonManage global quality claims and support Quality and Perfect Execution initiatives at Emerson. This hybrid role is based in Mandaluyong, Philippines.
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Gainwell Technologies dezvoltă soluții digitale și soluții bazate pe cloud pentru ecosistemul serviciilor sociale și al sănătății publice. Compania colaborează cu clienți din toate cele 50 de state ale SUA în cadrul unor inițiative de sănătate, inclusiv modernizarea Medicaid Enterprise, analiza datelor, serviciile pentru furnizori și soluțiile farmaceutice. Activitatea sa conectează tehnologia cu furnizarea serviciilor de sănătate publică, administrarea serviciilor medicale și eforturile de îmbunătățire a rezultatelor în materie de sănătate și a bunăstării comunităților.
Senior Medicaid Business Analyst, Configuration and Policy (Texas Remote)
Translate Medicaid policy into MMIS configuration, business rules, and design documentation. Support testing, deployment, client delivery, and healthcare technology projects for Gainwell Technologies.
Descriere
- Support business, policy, and technical delivery across MMIS and Medicaid Pharmacy functional areas
- Convert state and federal Medicaid requirements into product features, configurations, business rules, and design documentation
- Act as the primary domain and policy expert while advising the Engagement Lead
- Verify solution designs and configurations against CMS guidance, state policy, and approved business rules
- Assess functional, regulatory, and operational effects to support scope decisions and change control
- Lead and contribute to client and internal requirements and design workshops
- Create and maintain domain documentation for workflows, interfaces, X12 EDI transactions, letters, and reports
- Record and communicate domain decisions, risks, assumptions, dependencies, and downstream effects
- Contribute to domain configuration and implementation across Design, Development, and Implementation projects
- Coordinate with technical teams to ensure configurations reflect approved designs, policy interpretations, and business rules
- Review test cases and provide subject-matter expertise during System Integration Testing and User Acceptance Testing
- Analyze defects, investigate root causes, support fixes and retesting, and verify functional readiness
- Contribute to environment, data, process, and staffing readiness; readiness reviews; parallel and performance testing; cutover; operational transition; and hypercare
- Lead and support client communications, functional demonstrations, solution walkthroughs, and collaborative sessions
- Maintain documentation, transfer knowledge, and provide continuing operational support
Cerințe
- Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related discipline
- Five to eight years of hands-on experience supporting healthcare system implementations, including MMIS and Medicaid Pharmacy platforms
- Experience with QNXT or a comparable healthcare provider or claims management system
- In-depth knowledge of state and federal Medicaid policies, regulations, and program requirements
- Working knowledge of Medicaid functions such as claims, member, provider, and prior authorization processes
- Experience converting policy and program rules into system requirements, configuration guidance, and design documentation
- Strong SQL skills for data analysis and validation
- Demonstrated ability to communicate directly with clients and business stakeholders
- Ability to lead or assist with functional demonstrations, walkthroughs, and collaborative working sessions
- Strong documentation, facilitation, and analytical capabilities
- Experience delivering work in SDLC and Agile environments
- Knowledge of MITA, or Medicaid Information Technology Architecture, preferred
- Preferred experience with system integrations, EDI/X12 transactions, analytics, and reporting
- Familiarity with state and federal healthcare regulations and compliance standards preferred
Beneficii
- Fully remote work available from most US locations and territories
- Flexible working arrangements
- Learning and career growth opportunities
- Generous flexible vacation policy
- 401(k) plan with employer match
- Comprehensive health coverage
- Educational assistance
- Leadership and technical development academies
- Equal opportunity employment
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