Implementation and System Configurations

International Benefits Administrators; United States; Remote; USD 60,000 - 237,000; Full time

Job summary

A leading company is searching for an Implementation & System Configuration Specialist to work remotely. This role demands strong expertise in managing the Javelina platform, ensuring compliance, claims processing, and effective project implementation. Candidates should possess at least 5 years of relevant experience, focusing on system configuration and third-party administration processes.

Qualifications

• Minimum of 5 years in TPA-related roles.
• Recent experience with the Javelina platform.
• Strong understanding of EDI transactions specifically for claims.

Responsibilities

• Configure and maintain system implementations for new client builds.
• Coordinate closely with IT and business teams for system functionality.
• Utilize system reporting tools for compliance monitoring.

Skills

Javelina platform expertise

Claims processing

Project coordination

Compliance monitoring

System implementation

Job description

Implementation and System Configurations

Implementation and System Configurations

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Job Title: Implementation & System Configuration Specialist (100% Remote)

Position Overview:We are seeking an experienced Implementation & System Configuration Specialist to join our team in a fully remote capacity, Monday to Friday. This role requires a strong background in Third-Party Administrator (TPA) services, along with specialized experience in the Javelina platform. As a key player in system configuration and implementation, you will work closely with clients, business teams, and IT to ensure seamless system functionality, compliance, and effective claims processing.

Key Responsibilities:

• Javelina Platform Expertise:Must have at least 5 years of experience working with Javelina, including plan builds, adjudication logic configuration, master file maintenance, claims processing, EDI, JQS, and benefit accumulators.
• System Configuration & Maintenance:Configure and maintain system implementations to align with new client builds, renewals, and compliance requirements. Ensure that system parameters meet client-specific needs for claims processing, reporting, and compliance.
• Claims & Benefits Processing:Leverage a strong understanding of medical insurance benefits, claims processing, and eligibility to configure plan benefits and claims rules within the claim system.
• EDI Transaction Support:Provide support for EDI (837) file processing, ensuring efficient claims adjudication and data transfer.
• Client-Specific Alignment:Work to ensure that system configurations align with client-specific coverage, network rules, PBM setups, and regulatory requirements.
• Collaboration & Communication:Coordinate closely with IT, business analysts, account management, eligibility, and claims teams to ensure proper system functionality and successful project implementation.
• Reporting Tools:Utilize system reporting tools to track, analyze, and generate necessary reports for system monitoring and compliance purposes.

Required Qualifications:

• Minimum of 5 years of experience in TPA-related roles.
• Recent and hands-on experience with the Javelina platform is essential.
• Understanding of EDI transactions, specifically EDI (837) file processing for claims adjudication.
• Strong understanding of medical insurance benefits, claims processing, and eligibility.
• Familiarity with both self-funded and fully insured business models.
• Excellent project coordination and implementation skills.
• Ability to configure plan benefits and claims rules within claim systems, ensuring alignment with client-specific parameters.
• Compliance & Audit Screens:Track, view, and analyze all system activities to ensure compliance with regulations and efficient monitoring of platform usage.
• Set-Up Basic Plan:Streamline the creation and management of insurance plans, customizing options for coverage, cost-sharing, and eligibility criteria.
• Benefit Schedules:Define covered services, associated costs, and limitations or exclusions under a member’s insurance plan.

Additional Information:This position offers the flexibility of remote work, with a Monday through Friday schedule. If you're a detail-oriented, highly organized individual with strong expertise in system configuration and TPA processes.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  Insurance

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