Healthcare Claims Process Engineer

Job Overview

Pay Range: $47.96hr - $52.96hr

Requirement/Must Have

• Bachelor's degree in computer science, IT, or related field (or equivalent experience)
• 7+ years of experience in IT production support or operations
• Experience with CA-7 job scheduling and batch processing
• Strong analytical, troubleshooting, and problem-solving skills
• Proficiency in SQL and Oracle databases
• Experience with incident management processes and tools

Responsibilities

• Maintain daily production processes across platforms including Mainframe (z/OS), CA7, and Jenkins
• Monitor applications using Dynatrace and Jenkins for system health and performance
• Ensure successful execution of batch jobs and workflows; respond to alerts and system issues
• Diagnose, troubleshoot, and resolve job failures (abends), including restarting production and test jobs
• Provide Tier 1/L1 support for production applications and tenant systems
• Perform end-to-end incident lifecycle management including triage, analysis, resolution, and closure
• Conduct root cause analysis (RCA) and identify recurring incident patterns
• Document incidents, escalations, and resolutions in tracking tools (e.g., ServiceNow, SharePoint, Salesforce)
• Collaborate with development, QA, and infrastructure teams for issue resolution
• Analyze and process EDI 837/835 healthcare claims and XML files
• Investigate claim errors (e.g., 999 rejections) and ensure data integrity
• Write and execute complex SQL queries across multi-database (Oracle) environments
• Develop and maintain SOPs, runbooks, and system documentation
• Document monitoring design, workflows, and support processes
• Contribute to continuous improvement initiatives and operational efficiency

Nice To Have

• Knowledge of Claims Adjudication processes (Healthcare domain)
• Experience with EDI transaction standards and healthcare claims systems
• Exposure to object-oriented programming languages
• Experience working with Blue Cross Blue Shield (BCBS) or similar plans