HC & Insurance Operations Associate

NTT DATA, Inc.; Chennai District; On-site; INR 900,000 - 1,800,000; Full time

Job summary

NTT DATA, Inc. in India (Chennai region) seeks a seasoned pricing/configuration specialist for US healthcare claims. This role focuses on configuring provider contracts, pricing rules, QA testing, and issue resolution within a claims processing system.

You will collaborate with business owners and analysts, update configurations, and validate data across client databases. Strong SQL and VB.NET skills plus healthcare domain knowledge are essential.

Qualifications

• 5+ years experience in US healthcare Claims Payer.
• 6+ years 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.

Responsibilities

• Configure pricing provider contracts as per requirements and business rules of the new claims processing platform.
• Evaluate configuration requirements and formulate approaches with best practices.
• Create rules and complete configuration activities based on business rules.
• Troubleshoot health plan benefit, provider, pricing, reporting, operational and system issues.
• Resolve production support issues related to client configurations in the core administrative system.
• Support configuration updates in core claims processing system within Provider Pricing area.
• Support fee schedule changes including terms, affiliations and contract maintenance.
• Enable User Acceptance Testing (UAT) and implement modifications as advised by business owners/analysts.
• Create manual test cases from use cases, functional specs and requirements documents.
• Resolve coding/QA issues by managing master issue logs and high-priority changes.
• Data validation and audit of existing plans and contracts in client databases.
• Database management and maintenance.

Skills

SQL

US healthcare

Education

High school diploma or equivalent

Associates degree / technical college

Tools

VB.Net

Job description

Position's General Duties and Tasks

• 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

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 weekends basis business requirement.