Claims Requirements Analyst

Lyric, formerly ClaimsXten, is a leading healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated teams, and top technology help deliver more than $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric’s strong relationships as a trusted ally to customers resulted in recognition from KLAS as “true partner” and “excellent value for investment,” with a top score for overall customer satisfaction and A+ likelihood to recommend in their October 2023 Payment Integrity and Accuracy Report. Discover more at Lyric.ai. 

Applicants must already be legally authorized to work in the U.S.  Visa sponsorship/sponsorship assumption and other immigration support are not available for this position.

The Claims System Analyst is integral to the success of the policy and business development process at Lyric. This role is responsible for translating the clinical requirements into functional requirements and the creation of policy and rule specifications, incorporating best design practices. This role is vital to the expansion and effectiveness of our ClaimsXten editing packages and helps promote payment accuracy. Your workday will be self-directed and collaborative with cross functional teams, where clear communication will be vital to success.

Role Responsibilities:

• Translate clinical requirements into functional design documentation, incorporating best practices and clinical development protocols for ClaimsXten.

• Collaborate with Requirements team and cross-functional team members, to evaluate rule/policy behavior and to confirm that solution requirements meet business expectations and align with client implementation standards.

• Support the documentation of content requirements to promote immediate post release content maintenance handoffs.

• Serve as a contributor to all user documentation (edit clarifications, Rules Guide, etc.,)

• Assist with all end-user training activities.

• Peer review and contribute to Quality Assurance test plan validation, unit test reviews, and functional testing.

• Perform user acceptance testing (UAT) of policies and/or rules.

• Provide policy and rule logic subject matter expertise to internal and external clients

Basic Requirements:

• Education: Bachelor’s degree in a Computer/Information Systems or Healthcare related field required.

• 5+ years relevant experience as a Systems or Claims Analyst in a Healthcare organization required.

• 5+ years experience writing to write document flow statements in Visio or similar program

• 5+ years of demonstrated technical awareness regarding clinical development solutions, and understanding of the software development lifecycle

Preferred Qualifications:

• Previous experience supporting ClaimsXten is strongly preferred.

• Master’s degree in computer/information systems or healthcare related field.

• Knowledge of healthcare reimbursement and payment policies and methodologies.

• Working knowledge of pre-payment editing and payment integrity is preferred.

• Previous healthcare related experience in a technology role is a plus.

• Strong communication skills: Must be an expert at presenting extraordinarily complex material via all mediums.

• Analytical skills: Candidate must possess the ability to analyze complex data and assess potential vulnerabilities.

• Superior critical thinking skills

• Proficiency in Microsoft applications.

***The US base salary range for this full-time position is:

The specific salary offered to a candidate may be influenced by a variety of factors including but not limited to the candidate’s relevant experience, education, and work location. Please note that the compensation details listed in US role postings reflect the base salary only, and does not reflect the value of the total rewards compensation. ***

Lyric is an Equal Opportunity Employer that strives to create an inclusive environment, empower employees and embrace collaborative success.