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System interface requirements; requirements decomposition review; adjudication of Air System/Ground Stems Interface Control Documentation; support of system model development; review of UMCS model implementation; analysis of installation guidance, and integration gap analysis.
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Per State Statute 943.13 if you have been convicted of any felony or of a misdemeanor involving perjury of a false statement or if after July 1, 1981, you pled guilty or nolo contendere to or have been found guilty of any felony or a misdemeanor involving perjury or a false statement you are not eligible for employment or appointment as a Police Officer, notwithstanding suspension of sentence or withholding of adjudication.
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Firm understanding of Fee for Service (FFS), Managed Care claim adjudication processes from eligibility and enrollment to claims processing to funding/finance. This role will support analysis of two different data structures to support conversion and new data model development of a large-scale data warehouse using complex SQL. This includes providing direction for the solution, ensuring data quality, and support of the design, development, and implementation (DDI) of the project.
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DCSA Consolidated Adjudication Services (DCSA CAS), an agency of the Department of Defense, handles and adjudicates the security clearance process. Experience in integrating RF/EO sensor output, either modulated waveforms or streams of digital samples used for real-time representation of RF/EO scenes data collection / analysis (including Telemetry.
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The preparation of written reports for use in formal dispute resolution processes such as mediation, adjudication, litigation and most commonly arbitration; prepared as either advocate or assistant to an independent expert.
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Working knowledge of Employee Retirement Income Security Act of 1974, (ERISA) claims processing/ adjudication guidelines. Perform regulatory operations research to support guideline/SOP/workflow development, provide accurate analysis, documentation, and recommendations for improvements.
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Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination. Review reports and research pended claims to ensure timely adjudication within accepted corporate cycle times.
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Healthcare industry experience as it relates to risk adjustment, medical claims submissions, adjudication and payment, eligibility, encounters file management in particular for Medicaid/Medicare populations.
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Assist leadership team improve turnaround times, processes, or staff training identifying errors through data analysis and auditing, and working with various teams to ensure those errors are corrected in both the short and long term.
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Advanced proficiency in Microsoft Excel and other data analysis tools; experience with financial planning software is required; experience with Workday Adaptive Planning is preferred. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
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Experience in integration with test equipment, telemetry data analysis software, and missile systems host platforms. Perform data collection activities, including review and analysis of data elements, and provide detailed reports of results.
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Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), FSA, foreign claims, outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, and Medicare Secondary Payer (MSP) by calculating benefit due to approve or deny, based on SPD.
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Preferred Qualifications: Experience in integrating RF/EO sensor output, either modulated waveforms or streams of digital samples used for real-time representation of RF/EO scenes data collection / analysis (including Telemetry) Test Systems design experience and collaborating across multiple engineering disciplines, such as electrical, electronics, mechanical, software, and computer engineering.
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Familiarity with failure reporting, analysis, corrective action and/or fault tree analysis. Create/modify documentation in support of reviews associated with formal testing, which may include Test Readiness Review (TRR), Consent to Ship (CTS), and Test Data Review (TDR) packages.
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Job Duties: Provide SE support for assigned program(s), to include planning and execution to support the entire system life cycle, for all SE processes: Decision Analysis Technical Planning Technical Assessment Requirements Management Risk Management Configuration Management Technical Data Management Interface Management Develop SE program plans as required to document and guide government implementation, including coordination, review and adjudication of stakeholder comments.
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