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Healthcare/Insurance Industry Specific Skillset

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Healthcare/Insurance Industry Specific Skillset

Tech Alpha Global is one of the leading software company, with its exclusive services expertise in all Software services that fumes high demand in the job market, engagement applying unique mentor approach to help working professionals to grab a great career !

Job description

  • Knowledge of health insurance domains and processes including but not limited to claim processing, plan product & benefits (offerings), clinical management, pharmacy eligibility processes, PBMs, provider & provider networks, member 360 view etc.
  • Experience in crafting domain models for each line of business like offering, member, provider, claims, clinical etc.
  • Experience in solution patterns based on domain models for both real-time and batch integration.
  • Strong knowledge of HIPAA and PII/PHI and corresponding security measures needed for the same in the solution design.
  • Knowledge of Medicare and Medicaid compliance for all CMS government sponsored health plans.
  • Knowledge of various healthcare industry segments like individual, group plans including small groups, middle markets, nation accounts, self-insured, fully insured plan types.

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