HC & Insurance Operations Associate

NTT America, Inc.; Gurugram District; On-site; INR 900,000 - 1,300,000; Full time

Job summary

NTT America, Inc. seeks an experienced healthcare pricing configuration specialist to manage provider pricing rules and claims configurations. You will work in a project-driven environment, translating business rules into system configurations and tests.

The role emphasizes UAT support, rule creation, and data validation across client databases, with a focus on accuracy and timely resolution of production issues. Evening EST shifts may apply.

Qualifications

• Over 5 years of experience in US healthcare Claims Payer.
• 6+ years configuring client systems for pricing (Provider Contract) and 2+ years UAT testing.
• Ability to work in a project-oriented environment.

Responsibilities

• 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

Education

High school diploma or equivalent

Associates degree, technical college or some college coursework

Tools

SQL

VB/Vb.net

Job description

Position's General Duties and Tasks

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 weekend’s basis business requirement.