Join our team as an HC & Insurance Operations Associate, a pivotal role focused on optimizing client systems for healthcare pricing and claims processing. You will be instrumental in configuring provider contracts and ensuring adherence to business rules within our advanced claims processing platform.

This position offers the chance to contribute to critical aspects of health plan operations, including benefit configuration, pricing strategies, and reporting enhancements. Your expertise will be vital in solving complex issues and improving the overall efficiency of our systems.

Configure client systems for provider contract pricing according to established business rules for a new claims processing platform. Evaluate configuration requirements, develop configuration approaches, and implement advanced functionalities based on best practices. Gather business requirements and rules to create and execute configuration activities. Participate in resolving health plan benefit, provider, pricing, reporting, and system-related issues. Address production support challenges by analyzing and resolving client configurations within the core administrative system. Support updates to the core claims processing system, focusing on provider pricing configurations and fee schedule maintenance. Facilitate User Acceptance Testing (UAT) and implement approved modifications. Create manual test cases from use cases and functional specifications. Resolve coding and QA issues by managing issue logs and fixing high-priority change requests.

A strong background of over 5 years is required for candidates experienced in US healthcare claims payers. Possess 6 or more years of experience in configuring client systems for provider contract pricing, along with a minimum of 2 years in UAT testing. A High School Diploma or equivalent is mandatory; an Associate's degree, technical college coursework, or some college credits are preferred. Demonstrated ability to thrive in a project-oriented work environment is essential. Proficiency in SQL, including query writing, is preferred (2+ years). Familiarity with VB/Vb.net is considered an advantage.