Senior Manager, Claims Technical Analyst, Medicaid Intake Operations

Position Summary

As the Senior Manager, Claims Technical Analyst of the Medicaid Intake Operations Team you will play a critical role in ensuring the accuracy and integrity of all Electronic Data Interchange (EDI) and claims intake processes within the Medicaid line of business.

Primary Duties and Responsibilities

• Serve as the Technical Subject Matter Expert (SME) for intake rules and matching logic.
• Liaise with providers and internal teams to resolve questions about EDI and Claims Intake rejections.
• Provide second-level expert support for intake claim rejections.
• Analyze large datasets for research and troubleshooting.
• Collaborate with Product Owners and IT teams on system enhancements and fixes.
• Participate in testing and verification of business rules and validations.
• Manage multiple projects and tasks simultaneously while maintaining high-quality results.
• Support Product Owners, Business Owners, and Leads using technical and analytical expertise.
• Communicate effectively across all levels of the organization, including cross-functional teams.
• Write complex SQL queries to join multiple data sources and analyze data for root causes, trends, and opportunities.
• Analyze EDI and Claims intake rejections from internal and external inquiries, including provider calls.
• Track and execute solutions for identified issues.
• Perform User Acceptance Testing for logic changes and enhancements.
• Develop utilities, queries, and processes for post-production checkout of business rules and system fixes.

Required Qualifications

• 5+ years of experience as a SQL Server power user (coding and developing data extracts).
• 5+ years of data interpretation and analysis experience.
• 5+ years querying large datasets using SQL, SAS, or other data tools.
• Strong documentation skills; writing readable and reproducible code.
• Process improvement mindset; strives to simplify complex processes.
• Proficient in Word, PowerPoint, Excel.
• Experience working independently and prioritizing multiple deliverables.
• Experience managing conflicting priorities and concurrent projects.
• Excellent verbal and written communication skills with experience communicating technical information to non-technical audiences.

Preferred Qualifications

• Advanced Excel skills (pivots, formulas, V-lookup).
• 2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s).

Education

• Bachelor’s degree or equivalent work experience