Senior Applications Analyst

Senior Applications Analyst – TPA Systems & Claims Processing

WelbeHealth is a value-based healthcare organization that’s transforming the future of senior care by providing an all-inclusive care option to our most vulnerable senior population.

The Senior Applications Analyst oversees the implementation and maintenance of WelbeHealth's core and emerging technologies, including but not limited to, TPA, EMR, CRM, and home-based technologies and initiatives. The Senior Applications Analyst will design and evaluate new technologies, proactively diagnose and resolve problems, provide end user assistance, support strategy, complete table creation and configuration, and keep our enterprise technologies up to date as per the guidance and priorities of the Director or VP, IT Applications. This role will directly improve how efficiently we process claims, pay providers, and support scalable, tech-enabled health plan operations.

Essential Job Duties:

• Work independently to research, define, plan, and implement new TPA and claims processing system, supporting payer-side workflows including benefits, eligibility, prior authorization, and provider payments
• Configure and maintain adjudication logic, provider contract terms, and fee schedules within the TPA platform to ensure accurate claims processing, payment and encounter submissions
• Ensure TPA (Quick Cap) and integrated applications align with business requirements and systems goals, meet end-user needs, and identify and solve systems problems, as well as ensure data accuracy across claims, eligibility, and provider files to support efficient processing and reduce rework
• Oversee product updates for business applications, feature customization and improvement, maintenance, support, troubleshooting, and customer service
• Lead configuration, planning, and implementation of WelbeHealth’s business applications needs for new market entry (launch)
• Collaborate with the Training team to ensure new technologies and updates are included in training materials and curricula
• Perform workflow assessments, design workflows to match business requirements, and provide trainings and remote support on core technologies when needed, as well as assess existing business applications used in operations and identify opportunities for increasing value creation and developing process improvement plans accordingly

Job Requirements:

• Bachelor’s degree in relevant field; master’s degree preferred
• Minimum of five (5) years of experience with healthcare applications and technologies including:
  • Minimum of five (5) years of experience managing claims processing system functionality (e.g., design, configuration, testing, optimization, and support) in a healthcare payer, TPA, or claim delegated risk environment
  • Two (2) years of CRM or Care Management application experience preferred
  • Advanced Microsoft Excel and PowerPoint skills required; strong data analytics and visualization skills required; PowerBI a plus
• Minimum of three (3) years of experience in a healthcare delivery environment
• Minimum of three (3) years of experience in technology solutions value creation such as in a product management, consulting, or business analysis role in a data-driven, fast-paced, high-growth setting

Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• BENEFITS: Health Coverage on Day 1, Paid Parental Leave, 401K Match.
• PERKS: 17 days of paid time off in year one, 12 company holidays and 6 sick days
• GROWTH: Career path advancement and leadership opportunities