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SME Consultant, Claims Processing Oversight
The Judge Group
📍
United States, United States
Location
United States
Posted
June 19, 2026
Commute
Local Area
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Job Description
SME Consultant, Claims Processing Oversight
Position Overview:Configuration risk and defect assessment Conduct comprehensive assessment of medical claims platform configuration across FEHB and PSHB lines of business Identify configuration risks before they manifest as defects; produce a Top-10 claims defect inventory categorized by severity, member impact, and remediation complexity Review proposed configuration changes for medical claims processing logic; provide written assessment of risk before deployment Audit accumulator logic, benefit-build integrity, and provider-network configuration as recurring quality discipline Root-cause analysis discipline Develop recommended RCA template and discipline standards for adoption by the claims oversight function Lead root-cause analysis on member-impact incidents; produce documentation suitable for regulator scrutiny Build pattern-detection routines that co...
Position Overview: