Integrated Quality Domain Analyst (Claims)
Chicago, IL

Job Description

It's Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely-70.2% in year-over-year revenue growth in 2017. Are we recognized? Definitely. We have been named one of "Becker's 150 Great Places to Work in Healthcare" in 2016 and 2017, and one of the "50 Great Places to Work" in 2017 by Washingtonian, and our CEO was number one on Glassdoor's 2015 Highest-Rated CEOs for Small and Medium Companies. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

Who You'll Be Working With:

The Integration Quality (IQ) Department focuses on end to end (E2E) defect reduction. We test client implementations & major enhancements across each client's ecosystem meeting workstream based success criteria. Our team engages other Evolent, Health Plan, and Partner Testing Teams to prepare capability under test for operational readiness. Our framework and tools are employed to identify areas of confidence & risk across technical & operational workflow before production. Our employees bring leadership and rigor to each testing effort reusing assets as much as possible & conducting business to the IQ standard for risk mitigation.

What You'll Be Doing:

A domain represents a business area in the end to end healthcare ecosystem. Examples of domains include benefits, enrollment & billing, provider, reimbursement, utilization management, claims, mailroom, finance, customer service, portal, access to care, care management, outreach, fraud, quality, encounters, and reporting. Active domains under test require focused analysis to find the most valuable defects. The Domain Analyst (DA) reports to a domain lead and performs testing activities that provide assurance that the domain meets documented requirements. The DA is:

* cross-trained in multiple domains
* responsible to enforce department standards as directed by the domain lead
* responsible to support the domain lead during test case build and maintenance for assigned domain scope in a timely manner including:
* writing of test steps according to the system under test
* linking test cases to business and / or technical requirements
* providing feedback during case walkthroughs
* supporting test case selection from existing test assets to fortify regression testing
* ensuring test data from engineering is linked to test cases required for test case execution
* ensuring defects are entered and linked to test cases during execution
* supporting general improvement of the test case suite with domain lead support and guidance


* responsible to provide estimates for assigned work and informed of test case execution daily goals or deadlines set by the domain lead
* responsible for test execution as to daily goals or deadlines with accurate evaluation of each test recording of pass / fail against the assigned test case suite
* responsible to document risks / issues with assigned work and escalate to the domain lead for status reporting as required
* responsible to document and triage discrepancies, set defect priority & urgency, enter defects found by domain team, and assist in trouble shooting assigned domain scope during test execution
* responsible to escalate environment needs and outages to the domain lead
* responsible to support department and domain initiatives such as training documentation, access setup, execution, test data, environment activities, triage & defect documentation, status documentation, and collaboration across disciplines & departments
* responsible to attend and participate in test team meetings requested by the domain lead
* responsible to collaborate, coordinate, and communicate across disciplines and departments
* assigned other duties as required

Claims Domain Specific Experience:

* Strong experience with healthcare claims
* Experience testing in:
* Inpatient, Outpatient, Facility, Ambulatory, etc.
* Benefit configuration & setup
* Pricing and reimbursement (specific contracts, fee schedule pricing)
* Coordination of benefits
* Authorizations & Referrals
* Accumulators
* Code/Clinical editing


* Experience with enter claims manually
* Experiences with analyzing claim outcomes (pricing, benefits, etc)

The Experience You'll Need (Required):

* BS or BA Degree
* A minimum of 3 years formal quality assurance experience
* A minimum of 3 years operations or testing experience (can overlap with quality assurance experience) in at least one domain such as benefits, enrollment & billing, provider, reimbursement, utilization management, claims, mailroom, finance, customer service, portal, access to care, care management, outreach, fraud, quality, encounters, and reporting
* Demonstrable experience with a large System Integration Testing or User Acceptance Testing effort
* Demonstrable experience operating or testing at least one Medicaid, Waiver Program, Health Insurance Marketplace, Commercial, or Medicare healthcare implementation with an EPO, HMO, or PPO plan type
* Demonstrable experience operating testing activity for a domain under one mature SDLC (Software Development Life Cycle) under guidance of a leadership approved test plan (or test strategy)
* Demonstrable experience operating at least one test management and defect management tool
* Demonstrable experience creating and managing test cases with test data
* Demonstrable experience in verbal and written communication with management
* Demonstrable experience working concurrent projects, activities, and tasks under time constraints
* Demonstrable experience in problem solving, evaluation, processing of data to arrive at a conclusion
* Working knowledge of applicable domain terminology & code set vocabulary such as DRG, CPT, HCPCS, ICD10 diagnosis & procedure, revenue codes, fee schedules, contracts, pricing
* Working knowledge of Microsoft Word, Excel, and PowerPoint
* Experience to deliver job responsibilities listed above

Finishing Touches (Preferred):

* General knowledge of data flow and system landscape for the domain
* General knowledge of EDI transactions for the domain
* Confluence experience
* Zephyr experience
* JIRA experience

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.