💼 Full-Time Position

SME Consultant, Claims Processing Oversight

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The Judge Group
📍 United States, United States, United States
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Location
United States, United States
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Posted
June 19, 2026
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Type
Full-Time
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Full-Time Opportunity: This is a permanent, full-time position with a competitive package and real career growth potential.

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...