Remote

Outbound File Technical Analyst - LHB

Health Care Service Corporation
life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
United States
Feb 14, 2025
At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job SummaryThe Outbound File Technical Analyst is the SME (subject matter expert) for hundreds of outbound files in many different file layouts and formats for our client's vendors and works directly with programmers for new file builds and changes to existing files. This position involves analyzing a vendor file layout(s) and the needs of the particular vendor, writing business requirements, meeting with vendors and programmers to ensure understanding, creating test plans and testing scenarios, documenting testing results and collaborating with programmers to achieve the end result and finally providing user sign off for deployment of files to production. This position requires analytical and critical thinking skills to ensure that programming is accurate based on the needs of a client's vendor. In addition this position works with team members and other internal customers and external customers by analyzing a question or issue to either provide an explanation or determine if programming changes are needed and work with programmers to implement a change when needed. Problem solving and sound decision making skills are needed. Please note: While this role is based remotely, candidates must live in one of the following states to be considered: IL, IN, IA, KS, MO, MT, NM, NC, OK, PA, TX or WI. Outbound File Intake and Analysis Understands the overall purpose of why a vendor needs a particular file(s) Analyzes a vendor file layout(s) field by field Meets with vendor and/or client to obtain additional information when needs are unclear Facilitates ongoing communication with vendor and/or client Writes detailed business requirements Meets with programmers to ensure understanding of needs for each field on a file layout. Ensures that outbound data files are accurate so a client's employees have access to services purchased by a client, i.e., an outbound file to a PBM allows customers to obtain prescriptions; other files impact correct claim pricing by a network or allows access to vision or dental services If a data analytics vendor is involved, we need to ensure that we are sending the correct claim data so the vendor can provide accurate data to our client regarding how their plans perform and offer solutions to the client for better plan performance. Outbound File Testing Create test plans for a specific file(s) based on client and vendor criteria Create testing scenarios in the test region Perform review of test files field by field and document testing results. The review and testing cycle may occur multiple times. Collaborate with programmers on solutions to achieve the end result needed. Track progress and ensure due dates are met Provide final user sign off after all requirements have been met so programming can be deployed to the production environment Review and audit 1st production files to ensure production turnover accuracy Work collaboratively with team members, other internal departments and external customers to analyze and research a question, determine a solution and provide an explanation or request programming changes when necessary. Other duties as needed/assigned Required Job Qualifications: Bachelor's degree or equivalent experience required. Minimum of 4 years prior experience working in the insurance or TPA industry in a technical role working with EDI files and/or analyzing and testing electronic data files Understanding of EDI terminology and file structures Ability to read, understand and interpret file specifications Experience with SQL and compare tools like UltraEdit Proven problem solving, troubleshooting and analytical skills are essential. Ability to determine solutions and resolve issues with minimal supervision Ability to work collaboratively with team members and other Luminare Health areas as well as external vendors. Excellent organizational skills and the ability to prioritize workload in a frequently interrupted environment. Proficient with Excel and Word Strong written, verbal, collaboration and interpersonal communication skills Sound decision making skills Customer service focused Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! EEO Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Pay Transparency Statement: At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan,pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package forassociates. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan. Min to Max Range: $21.23 - $39.86