McKesson Claims Solutions Consultant (claims processing experience required) in King of Prussia, Pennsylvania

McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. McKesson Health Solutions delivers industry-leading clinical evidence and expert technology to help payers and providers collaborate for better healthcare outcomes at lower costs. Our solutions reduce unnecessary healthcare utilization while improving outcomes; operationalize complex volume- and value-based payment models; and optimize billing communication between providers, patients and payers. Our solutions are in more than four out of five payers in the country; more than 3,900 hospitals and facilities use our InterQual® evidence-based decision support criteria; and our RelayHealth® financial solutions are used to automate 1.9 billion financial transactions each year.

We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare.

Join our team of leaders to begin a rewarding career.

Position Description

The Claims Solution Consultant (CSC) is responsible for understanding their assigned clients claim systems and payment policies so they may document requirements for implementing services and rule engine components either during the initial and/or subsequent phase of software implementation. They are also responsible for supporting their clients during maintenance periods which may require researching issues, analyzing software behavior and remediating defects.

The Claims Solution Consultant must be an active consultative client facing participant within the assigned team structure to ensure quality client deliveries within targeted timeframes based upon work effort and allocation. They may at times be asked to work independently and without management oversight.

Key Responsibilities:

  • Effectively work as a ClaimsXten rules development subject matter expert on client implementations. This will require working consultatively with the client and documenting granular requirements for signature. Support implementation activity as required.

  • Address all assigned client issues & requests that are generated through the McKesson Services Support Center.

  • Effectively participate on internal or external ClaimsXten Service Delivery Team meetings and initiatives. Conduct training as needed.

  • Provide forecasting, supply requested metrics and attend or potentially lead team meetings.

  • Travel 10% to 15%


Minimum Requirements

4+ years experience in business analysis, requirements definition, building systems solutions and deployment of business requirements to information systems.

Critical Skills

  • 3+years of experience in health care combining first hand payor and consulting experience

  • Medical claims experience within payor environment ideal.

  • SDLC exposure needed.

  • Understands payor environments and claims management

  • High level 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

  • Understands medical terminology, healthcare industry terminology and medical coding terminology

  • Must be able to articulate the clinical value of products and services provided to clients

  • Delivers presentations effectively to the customer

  • Able to understand and articulate ClaimsXten rules development

  • Conducts customer meetings/trainings efficiently and effectively

  • High-level proficiency in the following software:

  • Word

  • PowerPoint

  • Excel

  • Visio


4-year degree in computer science or related field or equivalent experience

Physical Requirements

General Office Demands

Benefits & Company Statement

McKesson believes superior performance – individual and team – that helps us drive innovations and solutions to promote better health should be recognized and rewarded. We provide a competitive compensation program to attract, retain and motivate a high-performance workforce, and it’s flexible enough to meet the different needs of our diverse employee population.

We are in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.

But we can’t do it without you. Every single McKesson employee contributes to our mission—whatever your title, whatever your role, you act as a catalyst in a chain of events that helps millions of people all over the globe. Talented, compassionate people are the future of our company—and of healthcare. At McKesson, you’ll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that’s vital to us all.

McKesson is an equal opportunity and affirmative action employer – minorities/females/veterans/persons with disabilities.

Qualified applicants will not be disqualified from consideration for employment based upon criminal history.

Agency Statement

No agencies please.

Category: Technology