Healthcare Claims Processing Specialist

Role: Healthcare Claims Processing Specialist
Location: Remote
Job type: Contract
Duration: 12 Months.
Max Rate: $60-62/hr.

ROLE DESCRIPTION
Responsibilities:
• Strong understanding of Healthcare Claims Processing lifecycle, including adjudication, pricing, enrollment, provider, and member data flows.
• Experience working with legacy and modern claims platforms.
• Hands-on or working knowledge of Universe Database.
• Hands-on or working knowledge of Pick Basic Programming.
• Hands-on or working knowledge of .NET Technologies.
• Hands-on or working knowledge of SQL Development & Query Optimization.
• Hands-on or working knowledge of API Design, Integration, and Testing.
• Healthcare EDI implementation, modernization, transformation, or operations involving:
– 837 Claims
– 835 Remittance
– 270/271 Eligibility
– 276/277 Claim Status
– Enrollment transactions
– Acknowledgments
– Exception handling
– Reconciliation processes
• Ability to understand system architecture, application integrations, and technical dependencies.
• Experience working closely with architecture teams and translating high-level designs into actionable delivery tasks.
• Familiarity with cloud-based integration and enterprise architecture frameworks.
• Strong stakeholder management and executive communication skills.