Join our team as a Senior Specialist in BPO Configuration Analysis, focusing on client system setup for pricing and provider contracts within a new claims processing platform. This role is crucial for accurately reflecting business rules and ensuring efficient claims handling. You will evaluate configuration needs, develop effective approaches, and implement advanced functionality.

Your expertise will be vital in problem-solving various issues related to health plan benefits, provider contracts, pricing, reporting, and system operations. You will also support the resolution of production issues stemming from client configurations in the core administrative system. The position requires a proactive approach to updating configuration data, particularly in provider pricing and fee schedule maintenance.

This role involves supporting User Acceptance Testing (UAT), incorporating feedback from business owners, and creating comprehensive test cases. You will manage master issue logs, resolve coding and QA issues, and address high-priority change requests promptly. Data validation and auditing of existing plans and contracts are also key responsibilities, alongside database management and maintenance.

Configure client systems for pricing and provider contracts according to business rules and new claims processing platform requirements. Evaluate configuration needs and develop optimal approaches, integrating advanced features and best practices. Create and implement rules based on gathered business requirements and rules. Participate in troubleshooting health plan benefits, provider, pricing, reporting, operational, and system issues. Resolve production support issues related to client configurations within the core administrative system. Update configurations in the core claims processing system, focusing on provider pricing and fee schedule changes. Support fee schedule updates, including terms, affiliations, and contract maintenance. Facilitate User Acceptance Testing (UAT) and implement business-driven modifications. Develop manual test cases from use cases, functional specifications, and requirement documents. Manage Master Issue Logs and resolve coding/QA issues, prioritizing urgent change requests.

A minimum of 5 years of overall experience within the US healthcare claims payer industry is required. Possess at least 6 years of experience in configuring client systems for pricing and provider contracts, with 2+ years specifically in UAT testing. A high school diploma or equivalent is necessary; an Associate's degree, technical college coursework, or some college credits are preferred. Demonstrated ability to thrive in a project-oriented work environment. Proficiency in SQL for query writing is a plus (2+ years experience preferred). Familiarity with VB/VB.NET is considered an advantage.