HC & Insurance Operations Associate

NTT DATA, Inc.; Gurugram District; On-site; INR 800,000 - 1,200,000; Full time

Job summary

NTT DATA, Inc. is seeking an experienced professional to configure pricing for provider contracts within our health care claims platform. The role focuses on translating business rules into configuration, creating test cases, and validating data across client databases.

You will work in a project-driven environment, handling configuration updates, fee schedule changes, and problem resolution for production issues. Strong SQL and VB.NET skills are beneficial for success.

Qualifications

• 5+ years in US healthcare Claims Payer.
• 6+ years in Configuring client System for Pricing (Provider Contract) and UAT testing - 2+ Years.
• High school diploma or equivalent.
• Associates degree, technical college or some college coursework preferred.
• Ability to work within a project-oriented environment.

Responsibilities

• Configure client system for pricing (Provider Contract) as per requirements and business rules.
• Evaluate configuration requirements and formulate configuration approach with best practices.
• Create rules and complete configuration activities based on business rules.
• Participate in problem solving of health plan benefit, provider, pricing, reporting, and system issues.
• Support activities to update configuration within core claims processing system, especially Provider Pricing.
• Assist with fee schedule changes including terms, affiliations and contract maintenance.
• Enable UAT and implement modifications as directed by business owners and analysts.
• Create manual test cases from use cases and specs.
• Data validation and audit of existing plans and contracts in client databases.
• Database management and maintenance.

Skills

Analytical thinking

Attention to detail

Project teamwork

Problem solving

Education

High school diploma or equivalent

Associates degree preferred

Tools

SQL

VB.NET

Job description

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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:

• Candidats 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.

Job Segment: Database, Quality Assurance, SQL, Technology

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.