HC And Insurance Operations Associate

NTT DATA, Inc.; Gurugram District; On-site; INR 6,783,000 - 9,690,000; Full time

Job summary

NTT DATA, Inc. is seeking professionals with strong experience in US healthcare Claims Payer systems to configure pricing (Provider Contracts) and manage UAT testing. The role involves evaluating configuration requirements, building rules, and supporting production issues across provider pricing and fee schedules.

A project-oriented environment and data validation duties are expected. The position requires collaboration with business owners and analysts to implement modifications, create test

Qualifications

• Five+ years' experience in US healthcare Claims Payer.
• Six+ years configuring pricing (Provider Contract) and UAT testing.
• High school diploma or equivalent; associate degree preferred.
• Ability to work within a project-oriented environment.

Responsibilities

• Configure client system for pricing (Provider Contract) as per requirements.
• Evaluate configuration requirements and formulate approach; include advanced configuration.
• Create rules and complete configuration activities based on business rules.
• Participate in problem solving of health plan benefit, provider, pricing, reporting, operations, and system issues.
• Support updates to configuration within the core claims processing system, especially Provider Pricing.
• Assist with fee schedule changes including terms, affiliations and contract maintenance.
• Enable User Analysis Testing (UAT) and implement modifications per business owner requests.
• Create manual test cases from Use cases and functional specs.

Skills

UAT testing

SQL

Data validation

Problem solving

Education

High school diploma or equivalent

Associate degree or some college

Tools

VB.NET

SQL Queries

Job description

Job Description:

Positions General Duties and Tasks

In these roles you willbe 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) andUAT 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.

Requirements: