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.
- 3 + year(s) experience in Configuring client System for Pricing (Provider Contract) and UAT testing.
- 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.
