HC & Insurance Operations Associate

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.