Healthcare Claims Configuration Specialist

Configuration Analysis Specialist

Our client provides access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well. NTT is contracted to manage provider pricing configuration which involves Payor Platform configuration, perform UAT, Integration Testing and Audit. Our NTT Business Process Outsourcing (BPO) team has helped client to improve productivity, TAT and quality to strengthen the configuration area and help our customer relationship stay competitive and improve member and provider satisfaction.

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.

Experience Level

Mid Level