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Claims Solution Consultant

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Job Details
Job Order Number
Company Name
Change Healthcare
Physical Address
Company Worksite
Portland, ME 04103
Job Description

Transforming the future of healthcare isn’t something we take lightly. It takes teams of the best and the brightest, working together to make an impact.

*As one of the largest healthcare technology companies in the U.S., we are a catalyst to accelerate the journey toward improved lives and healthier communities.Here at Change Healthcare, we’re using our influence to drive positive changes across the industry, and we want motivated and passionate people like you to help us continue to bring new and innovative ideas to life.

If you’re ready to embrace your passion and do what you love with a company that’s committed to supporting your future, then you belong at Change Healthcare.*

Pursue purpose. Champion innovation. Earn trust. Be agile. Include all.

Empower Your Future. Make a Difference.

Location: King of Prussia, PA or remote

Position Description:

The Claims Solution Consultant (CSC) role functions to implement and maintain the ClaimsXten Select (CXT) Rules and Rule Logic for customers’ use. As such, the CSC is assigned customers, as part of the Services Delivery Team, to understand the customers’ claim system(s), payment policies, and integration data elements managed using CXT for total payment accuracy, to carryout actions and activities such as

  • Consulting, gathering, and documenting intent and technical requirements for rules and non-rule work
  • Triage, troubleshooting, and problem-solving for rule and non-rule issues reported during implementation and upgrade projects, Go Live, and post Go Live production support
  • Guiding customers thru impacts for routine CXT content and rule updates
  • Estimating level of effort for new or existing rule work for forecasting and/or pricing
  • Confirmation of milestone completions by supporting works to trigger customer invoicing
  • Collaborating with Sr CSC and Engagement Managers for planning and managing client works
  • Meeting and exceeding metrics such as utilization, time entry, forecasting, etc.

As a CSC, for rule and non-rule work, he/she will:

  • In conjunction with his/her assigned Service Delivery Team (i.e., including any off-shore resources) ensure high quality, on-time client deliveries.
  • Assert confidence and reliability as a trusted adviser to drive client facing initiatives through to conclusion.
  • Work on issues where analysis of situations or data requires an evaluation of intangibles.
  • Follows and maintains compliance with current methodologies, tools, procedures and processes. And in collaboration with Service Delivery Team members and supporting departments to ensure high quality work output and customer satisfaction.


  • Effectively work as customer-facing ClaimsXten Select rules development resource for successful client implementations, upgrades, and on-going production support use of the software. This will require consulting on rule development for customer intent, gathering and documenting technical requirements, troubleshooting rule behavior, testing rule functions, supporting QA testing, defect remediation, managing Pivotal (CRM), JIRA, CRB and other methodology processes, etc.
  • Effectively participate in ClaimsXten Select Service Delivery Team meetings, initiatives and metrics. Function as team member in support of all goals and objectives.
  • Effectively support internal special projects for the purposes of evaluating, improving, correcting, or newly implementing initiatives, objectives, new feature functions, defect remediations, etc.
  • Provide forecasting inputs for project works, supply requested metrics and attend all team meetings. Work with the Engagement Manager and Sr CSC to determine internal project milestones to drive client deliveries.

Minimum Requirements:

  • 4 – 8+ years of experience in health care combining first hand payor and consulting experience
  • 2 – 5 years of medical claims experience within payor environment required
  • SDLC exposure needed

Critical Skills:

Customer’s Business

  • High level of expertise in payor environments and claims management
  • Granular understanding of different customer segments (national, strategic and/or specialized business)
  • High level understanding of claim architecture, infrastructure, and multiple platforms
  • Discusses customer issues (pains and trends) confidently with customers
  • Project deliverables coordination to ensure high quality rule readiness outcome, and milestone completions for customer invoicing


  • High level of understanding of medical terminology, healthcare industry terminology and medical coding terminology
  • Must be able to articulate the clinical value of products and services provided to clients


  • Confidently delivers presentations effectively to the customer
  • Confidently understand and articulate ClaimsXten Select rules development
  • Confidently conducts customer meetings/trainings efficiently and effectively

Software Tools

  • High-level proficiency in the following software:Word

Additional Knowledge & Skills:

  • Medical coding knowledge helpful

Education / Training:

  • Bachelor’s Degree in computer science, healthcare related field, or equivalent business experience

Physical Requirements:

  • Environment – Office environment, up to 10 to 15% travel required, may require work performed outside normal business hours, to include nights and weekends to support customer activity.
  • Physical Requirements – Sitting, standing, walking, and using key board.

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

Equal Opportunity/Affirmative Action Commitment

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

Change Healthcare is an Equal Opportunity Employer. Employment at Change Healthcare is based upon your individual merit and qualifications. We don’t discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, marital status, protected veteran status or disability, genetic characteristic, or any other characteristic protected by applicable federal, state or local law. We will also make all reasonable accommodations to meet our obligations under the Americans with Disabilities Act (ADA) and state disability laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability.

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