Position's General Duties and Tasks

In these roles you will be responsible for:

Configuring client System for Pricing (Provider Contract) as per the requirement and according to defined business rules of new claims processing platform.
Evaluation of Configuration Requirement and Formulation of Configuration Approach and Effectively include advanced configuration and additional functionality based on best practices
Based on the business requirements and business rules gathered, evaluate and create rules and complete the configuration activities
Participate in problem solving of Health Plan benefit, provider, pricing, reporting, operational and system issues
Perform a variety of tasks related to the resolution of production support issues based on client configurations with the core administrative system
Support activities to update configuration within the core claims processing system, typically within the areas of Provider Pricing. Potential responsibilities include and may vary by system area of assignment
Support fee schedule changes including terms, affiliations and contract maintenance
Enable User Analysis Testing (UAT) and implement the modifications as suggested by the business owners and/or analyst
Creating manual test cases from Use cases, Functional specs and other requirement documents.
Resolve coding/QA issues by managing Master Issue Logs and Fixing the high priority change requests which require immediate attention
Data Validation and Audit of existing plans and contracts in the client database(s)
Database Management & Maintenance

Requirements for this role include:

Candidates must have Over all 5+ years experience in US healthcare Claims Payer.
6 + year(s) experience in Configuring client System for Pricing (Provider Contract) and UAT testing – 2+ Years.
High school diploma or equivalent required, Technical/ Non-Technical
Associates degree, technical college or some college course work preferred
Ability to work within a project-oriented environment.

Preferences: -

Experience in SQL 2+ Years (Queries Writing)
Exposure on VB/Vb.net.

Required schedule availability for this position is Monday-Friday (5:00am to 3:00pm EST). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.

BPO Configuration Analysis Senior Specialist

BPO Configuration Analysis Senior Specialist