• Perform daily verification of system and algorithm functionality; • Validate that data is correctly received, processed, and calculated; • Approve daily system operation according to a rotation schedule, including weekends and holidays; • Validate new products and changes to existing products; • Analyze the impact of changes on data, reports, and business rules; • Work closely with Product and Engineering teams; • Provide technical customer support through ticket management and resolution; • Identify, document, and communicate system inconsistencies, failures, or bugs; • Prioritize tasks based on urgency and business impact.

• Advanced-level role responsible for auditing and evaluating internal Commercial claims operations and Third-Party Administrator (TPA) claim handling performance • Analyze adherence to claims handling standards, regulatory requirements, SLAs, and KPIs • Identify operational, compliance, and claim quality risks and provide recommendations for improvement • Develop and enhance audit methodologies, scorecards, reporting tools, and operational dashboards

• Test and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements. • Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors. • Resolve configuration errors in a timely manner and document changes. • Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms. • Maintain comprehensive documentation for benefit configuration, ensuring that processes and procedures are well-documented. • Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding. • Perform audits on all clinical documents and prepare coding to provide support to all services. • Perform research on various coding methods and facilitate all plans to resolve all discrepancies and coordinate with all clinical and non-clinical groups to manage documents according to required guidelines. • Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues. • Review procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes. • Analyze and maintain all code master files for all inappropriate codes and inform staff for same and collaborate with staff to resolve all coding issues and ensure accuracy of same. • Perform testing of coding and policy changes via reports, claim adjudication and other testing software. • Manage and resolve all discrepancies in entry of codes and maintain knowledge on all procedural codes and reimbursement plans and prepare reports for all coding guidelines. • Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies. • Participate in and support all training in regard to new benefit designs or benefit changes as the result of CMS or other insurance regulations.

Role Description Estamos buscando un/a Analista Cobol CICS Db2 para incorporarse a un proyecto estable y de largo recorrido, participando en la definición funcional y técnica de soluciones dentro de un entorno Mainframe. - Personas con iniciativa, autonomía y capacidad de liderazgo técnico. - Profesionales que asuman la responsabilidad de sus proyectos y sean capaces de impulsar las tareas de principio a fin. - Capacidad para desenvolverse con independencia y tomar decisiones dentro de su ámbito de responsabilidad. - Actitud resolutiva y orientación a la mejora continua. - Excelente capacidad de comunicación y colaboración con equipos multidisciplinares. Qualifications - Experiencia mínima de 5 años como Analista en entornos Mainframe. - Experiencia previa demostrable en Cobol-CICS-DB2. - Capacidad para analizar requerimientos funcionales y transformarlos en especificaciones técnicas. - Experiencia en interlocución con usuarios y áreas de negocio. - Capacidad para trabajar de forma autónoma, tomando decisiones y gestionando iniciativas con mínima supervisión. - Perfil proactivo, resolutivo y orientado a resultados. Requirements - Análisis funcional y técnico de requerimientos. - Diseño de soluciones en entornos Cobol, CICS y Db2. - Elaboración de documentación funcional y técnica. - Coordinación con equipos de desarrollo, usuarios y áreas de negocio. - Supervisión de pruebas y soporte a la implantación. - Identificación de mejoras y optimización de procesos y aplicaciones. - Liderar de forma autónoma el análisis y seguimiento de las iniciativas asignadas. - Proponer mejoras funcionales y técnicas que aporten valor al negocio. - Garantizar la calidad de las soluciones y el cumplimiento de los plazos establecidos. Benefits - Un entorno de trabajo excelente. - Oportunidades de desarrollo profesional y crecimiento continuo. - Contrato indefinido y modalidad de trabajo en remoto desde España o Andorra. - Soporte para capacitación y certificaciones.