Virginia Premier Health Plan, Inc.

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Claims Systems Analyst III

Claims Systems Analyst III

Job Locations 
US-VA-Glen Allen
Job ID 

Job Description


The Systems Analyst III performs complex configuration activities and should demonstrate an extensive expertise in the core claims adjudication system and all interface applications, both customized and packaged.  This individual should posses a high degree of expertise in the configuration of business rules that support reimbursement policies and methodologies of the organization.  The analyst will coordinate and maintain assigned Claims Department systems for the program and play a key role in the configuration and implementation of new markets and products.  The analyst should consider interdepartmental impact when recommending and implementing solutions.  Responsibilities include but are not limited to the maintenance of the core claims adjudication system; system configuration for provider/hospital contracts, benefit plans, Fee schedule loads; claim analysis, testing, documentation and reporting.  He or she may be the primary contact for one or more claims system interface applications and is expected to provide a high level of expertise with matters relating to this interface and its functionality.


In addition the Systems Analyst III will be responsible for managing configuration projects, coaching junior analysts and for preparing performance reports for the department.  He or she will work with peers in the department to establish realistic project scope, project plans and timelines.   


  • Maintain and support the Claims department as assigned, including complex configuration, stand-alone software systems, core claims system functionality and reporting
  • Serves as the Claims department point of contact for a program application and translate business goals into configuration requirements
  • Identify key components of a project; evaluate alternative configuration options and the impact across the organization; identify risks and propose the best configuration solution
  • Perform complex data analysis and draw business conclusion for decision making
  • Create complex design documents through the assessment of requirements
  • Evaluate current configuration and recommend improvements
  • Manage projects for the program that may involve other departments and/or personnel
  • Initiates Root Cause Analysis and Influences Corrective Actions with Functional Leadership
  • Serve as a resource to others for troubleshooting configuration issues
  • Assess the work of other team members
  • Provide training to new configuration staff members
  • Develop and maintain departmental performance reports



  • Bachelor’s Degree in Computer Science, Information Systems, Business or related technical field, required


  • Proven ability to analyze data and processes
  • Ability to retrieve and analyze complex data using Microsoft Access, Excel and SQL
  • Strong knowledge of software implementation / development life cycle
  • Strong verbal and written communication skills with demonstrated ability to research, problem solve, trouble shoot, influence, present and partner across the organization
  • Proficient knowledge of flow charting/process mapping
  • Proven ability to work independently while managing multiple tasks and priorities
  • Demonstrated ability to independently lead multi-functional projects
  • Managed Care; Medicaid or Medicare Insurance
  • Functional knowledge of healthcare claims system
  • Functional understanding of health care claim data sets such as ICD-9/10, CPT and HCPC                                        


  • 3-5 years in strong analytical roles preferred
  • 3+ years business experience possibly including Claims or Healthcare related experience (preferably Medicaid Managed Care or Medicare)
  • 3+ years experience working in Information Systems (software installation, system configuration, SQL/Oracle platforms)
  • 3+ years experience writing TSQL or SQL queries
  • 3+ years MS SQL server experience including: SQL Server Analysis Services 2005/2008, SQL Server Reporting Services 2005/2008, SQL Server Integration Services 2005/2008


  • Physical health sufficient to meet the ergonomic standards and demands of the position


About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


Our mission is to inspire healthy living within the communities we serve!



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