Job Details

Job Details

Functional Analyst for WCM

Job Code Number

403332693

Job Description

V2Soft is a global leader in IT services and business solutions, delivering innovative and cost-effective technology solutions worldwide since 1998. We have We have headquartered in Bloomfield Hills, MI and have 16 offices spread across six countries. We partner with Fortune 500 companies to address complex business challenges. Our services span AI, IT staffing, cloud computing, engineering, mobility, testing, and more. Certified with CMMI Level 3 and ISO standards, V2Soft is committed to quality and security. Beyond our work, we actively support local communities and non-profits, reflecting our core values. Join us to be part of a dynamic and impactful global company!

Please visit us at www.V2soft.com to know more.Functional knowledge:

Utilization management and prior authorization — authorization lifecycle, medical necessity review, inpatient and outpatient requests, determinations, appeals and turnaround obligations.
Care and disease management — case creation and stratification, care plans, assessments, member outreach, vendor referral.
Benefit configuration — how program and product benefits map to purchasing groups, including base and buy-up tiers.
Membership and eligibility — Commercial, Federal Employee Program and Medicare Advantage, and how coverage periods drive case and authorization behavior.
Quality and regulatory — HEDIS, NCQA accreditation and Star ratings, and how application data supports them. CMS interoperability awareness an advantage.
Correspondence — member and provider letter generation and the regulatory timing attached to it.

Platform experience:

Highly desirable — Cognizant CareAdvance (care and utilization management) and CareAdvance Provider / E-Referral (provider prior authorization portal) in a payer environment.
Also relevant — TriZetto CareAdvance, Facets, QNXT, HealthEdge GuidingCare, ZeOmega Jiva, Altruista, or an equivalent in-house UM/CM system.
Transactions and interfaces — EDI X12 278 authorization request and response; 834, 837 and 835 useful. FHIR and clearinghouse integration such as Availity an advantage.

Technical skills:

SQL — confident writing queries against Oracle and SQL Server to validate requirements, trace a record and confirm a defect. A working requirement, not a nice-to-have.
Data structures — able to read a data model and follow a field from source file through staging to the consuming application.
Tooling — JIRA, Confluence or SharePoint, TOAD or SQL Developer. ETL concepts (Informatica or similar) and batch scheduling exposure useful.
Testing — test case design, UAT coordination and defect triage. Postman or SOAP UI for web service validation an advantage.

Certifications: IIBA CBAP or ECBA; PMI-PBA; CSPO. AHIP or AHM 250 payer certification desirable
V2Soft is an Equal Opportunity Employer ( EOE). We welcome applicants from all backgrounds, including individuals with disabilities and veterans.
https://www.v2soft.com/careers - to view all of our open opportunities and to learn more about our benefits.

Organization Profile

Employer Name:

V2soft Inc.

Address:

300 Enterprise Court

Address Line 2:

Suite 100

City:

Bloomfield Hills

State/Province/Region:

Zip/Postal Code:

48302

Description:

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Job Summary

Organization

V2soft Inc.

Location

Bloomfield Hill, MI 48302

Job Code Number

403332693

Positions Available

Expiration Date

9/21/2026

O*NET Code

15-1211.00

O*NET Occupation

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