Senior Business Application Expert - Claims XTen

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POST DATE 9/15/2016
END DATE 10/14/2016

Blue Cross and Blue Shield of North Carolina Durham, NC

Durham, NC
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


Job Description:

The Business Application Expert provides expert application knowledge that is global for a business area rather than being single process focused. These applications support core business processes such as claims adjudication, membership enrollment, financial processing, etc. PowerMHS AMYSIS, and Lawson are examples of core processing systems. The incumbent is sought when there is application considerations needed due to problems, projects, or for overall assessments. This role s oversight and strategic thinking skills ensures that comprehensive, efficient solutions are being developed and implemented without negatively impacting the current operating environment and systems. This expertise is usually difficult to find in the marketplace. Will be the Superuser expert for the business unit on an application. Will represent business on complex corporate projects. Coordinates the resolution of production problems; works with various areas to support the user and to ensure operational stability. Acts as the Business Lead on the resolution of production problems and procedural problems; performs initial triage for severity and business impact of application failures; documents a plan of action to ensure resolution; escalations are primarily resolved without upper management involvement. Responsible for resolutions that affect multiple business areas or applications. Provides timely and accurate assessment of data presented for root cause analysis to ensure ultimate system performance. Ensures efficiency of tools for day-to-day business use, for advanced trend analysis, and timely problem resolution. Demonstrates expert understanding of the file structure for the business application supported and the data elements within, in order to provide timely resolutions and/or assess business area impacts; knowledge of business area is deep and equates to an expert understanding of the underlying applications/systems. Provides input into the preparation of Business Cases for system or process changes. Serves as an expert contact for other areas within the company, providing operational data in a consistent, precise, and timely manner. Utilizes system access tools, such as Query Manager, to extract needed data for evaluation. Leads teams in assessment of business issues; determines next steps, documents findings, and communicates action steps. Serves as the expert on vendor application issues that require a re-creation of the issue and works with vendor managers to ensure timely resolution. Coaches and mentors less senior Business Systems Analysts in addressing systems issues; provides direction in assessing process problems. Hiring Requirements Undergraduate degree 7 years of application experience in Claims In lieu of a degree, 9 years application experience in the hiring area will be considered. Hiring Preferences 5 years in an claims processing experience preferred Ability to use automated tools to perform detailed analysis and reporting Ability to use automated tools for problem resolution, such as TAB or ROBOT Ability to lead a diverse workgroup to address problem/procedural resolutions Proven ability to work independently Excellent research, analytical, and problem solving skills Excellent presentation skills Claims Xten experience CXT configuration experience Certified professional coder CPC-P Previous configuration experience with similar clinical/reimbursement editing applications such as ClaimCheck or iCES.

Company Description:

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina. Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We are committed to better health and better health care in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Our company is a not-for-profit with headquarters in Durham and major operations in Winston-Salem and Fayetteville. In all we employ more than 4,500 North Carolinians and serve more than 3.7 million customers.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.