Claims Systems Lead Analyst (EviCore)

Location: Remote role associated with Franklin, Tennessee, United States

Company

Evernorth Health Services, a division of hirify.global, develops pharmacy, care, and benefit solutions through EviCore claims processing services.

What you will do

• Manage complex claims systems projects, implementations, enhancements, and configuration work within the claims adjudication engine.
• Define business, technical, and claims data exchange requirements, including provider, member, authorization, and claims file mapping.
• Act as a claims systems subject matter expert for internal departments and lead external client calls.
• Create test plans and use cases, perform system integration testing, and support user acceptance testing.
• Use Microsoft SQL queries and Microsoft Access to analyze claims data, update configuration, and investigate processing issues.
• Perform post-production validation, document application functionality, and mentor senior analysts on complex designs.

Requirements

• Bachelor's degree in a computer-related field preferred, or equivalent work experience.
• At least 5 years of claims and healthcare experience, with medical claims systems configuration experience preferred.
• Complex query experience with Microsoft SQL and proficiency in Microsoft Access, including queries and data manipulation.
• Proficiency in Microsoft Excel, including pivot tables, charts, and formulas.
• Knowledge of claims lifecycles, claims adjudication frameworks, and industry-standard data types and editing rules such as ICD, CPT/HCPC, Rev Codes, and NCCI.
• Strong critical thinking, communication, database management, testing, and SDLC skills; client-facing experience is preferred.

Culture & Benefits

• Full-time employment with independent work and decision-making responsibilities.
• Collaboration with claims configuration, client engagement, IT development, QA, reporting, and business operations teams.
• Remote work may be performed occasionally or permanently with a cable broadband or fiber connection providing at least 10 Mbps download and 5 Mbps upload speeds.
• Tobacco-free employment policy applies where legally permitted.