Claims Solutions Consultant (Medical Claims Processor)



The Claims Solution Consultant (CSC) is responsible for understanding their assigned clients claim systems and payment policies so they may document requirements for implementing services and rule engine components either during the initial and/or subsequent phase of implementation. They are also responsible for supporting their clients during maintenance periods which may require researching issues, analyzing software behavior and remediating defects.


The Claims Solution Consultant must be an active consultative client facing participant within the assigned team structure to ensure quality client deliveries within targeted timeframes based upon work effort and allocation. 


Key Responsibilities (List the top four to six essentials responsibilities in priority order):


1.    Effectively work as a ClaimsXten rules development subject matter expert on client implementations. This will require working consultatively with the client and documenting granular requirements for signature. (60%)

2.    Address all assigned client issues & requests that are generated through the McKesson Services Support Center. (20%)

3.    Effectively participate on internal or external ClaimsXten Service Delivery Team meetings and initiatives. Conduct training as needed. (15%)

4.    Provide forecasting, supply requested metrics and attend or potentially lead team meetings. (5%)


Minimum Job Qualifications:


I.             Education/ Training

a.    Bachelor’s Degree in Computer Science, Healthcare Related Field, or equivalent business experience

II.           Business Experience

a.    3+years of experience in health care combining first hand payor and consulting experience

b.   Medical claims experience within payor environment ideal.

c.    SDLC exposure needed.

III.          Critical Skills

a.    Understands payor environments and claims management

b.   High level understanding of different customer segments (national, strategic and/or specialized business)

c.    High level understanding of claim architecture, infrastructure, and multiple platforms

d.   Discusses customer issues (pains and trends) confidently with customers

IV.          Clinical

a.    Understands medical terminology, healthcare industry terminology and medical coding terminology

b.   Must be able to articulate the clinical value of products and services provided to clients

V.           Communication

a.    Deliver presentations effectively to the customer

b.   Able to understand and articulate ClaimsXten rules development

c.    Conducts customer meetings/trainings efficiently and effectively

VI.          Software Tools

a.    High level proficiency in the ff. software

                                         i.   Word

                                        ii.   PowerPoint

                                       iii.   Excel

                                       iv.   Visio

Salary: ₱40000 - ₱70000
Address: 18F Picadilly Star Building 4th ave cor 27th Street, BGC, Taguig