Claims Application Analyst

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November 27

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Shyft6

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HR Tech • Recruitment • B2B

Shyft6 is a trusted partner for innovative companies, specializing in workforce solutions that encompass staffing and recruiting, workforce management, and human capital strategy. With over 26 years of combined experience, Shyft6 offers a comprehensive range of services including contingent workforce supplier management, recruitment process outsourcing, staff augmentation, executive search, and multi-state payroll. Their focus is on empowering organizations through effective workforce development and project management, ensuring successful delivery and skilled talent acquisition.

201 - 500 employees

Founded 2019

👥 HR Tech

🎯 Recruiter

🤝 B2B

📋 Description

• Lead and support Tapestry Claims build, configuration, testing, and deployment activities. • Analyze requirements related to claims processing, benefit structures, contract configuration, and adjudication rules, translating them into scalable system designs. • Troubleshoot claims errors, pricing discrepancies, configuration gaps, and end-to-end adjudication issues. • Collaborate with operational teams (Claims, Provider Relations, Contracting, UM/CM, Finance) to optimize workflows and resolve system defects. • Configure and maintain benefit plans, coverage records, provider contracts, fee schedules, claim edits, accumulators, and reimbursement logic. • Support integration points with related Epic modules such as Membership, Enrollment, Referrals, PB/HB, and external payer systems. • Develop test plans, execute test cases, document results, and support user acceptance testing. • Participate in release and upgrade activities including regression testing, validation, and remediation. • Provide knowledge transfer and mentorship to internal analysts and project stakeholders.

🎯 Requirements

• Epic Tapestry Claims certification (current, former, or NVT accepted). • 3+ years of professional experience supporting Epic Tapestry Claims in a build/configuration role. • Strong expertise with claims adjudication logic, benefits configuration, and provider contract setup. • Solid understanding of managed care processes, regulatory compliance requirements, and industry-standard claims workflows. • Proven ability to troubleshoot complex claims issues and partner with operational teams to resolve root causes. • Excellent communication, analysis, documentation, and stakeholder-management skills.