Shyft6
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.
Claims Application Analyst
Job not on LinkedIn
November 27
Shyft6
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.
📋 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.
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