• US Citizen

• Green Card

• EAD (OPT/CPT/GC/H4)

• H1B Work Permit

• Corp-Corp

• Consulting/Contract

• UG :- - Not Required

• PG :- - Not Required

• No of position :- ( 1 )

• Post :- 1st Aug 2022

• This position is responsible for creating, updating, and validating Claims pricing configurations. Deep understanding of Claims processing and pricing workflows for multiple Lines of Business including FEP, BCBS Association mandates. Collaborate with the Product owner to assess changes in the pricing configuration based on Benefit Plans, Products and Business rules. Responsible to work with business SMEs to identify and document pricing configurations and policies. Act as point of contact for pricing release notes, requirements and test cases related to Claims system upgrades, mandates, enhancements, break/fix work and maintenance releases. Work alongside business and technical teams to increase collaboration and optimize productivity and communication.
• Responsibilities:

• Create new and modify existing Claims Pricing configurations. Validate changes and payments through testing. Document pricing changes for review and future references.
• Analyze Pricing changes and impact to the Claims payment processing.
• Own the delivery of the Requirements, document Pricing requirements; develop business case, process map and impact analysis and create traceability of the business requirements to technical requirements, test cases and User Acceptance Test (UAT) cases.
• Evaluate and recommend configuration solutions to Business and IT leadership.
• Collaborate with the operational team in resolving Pricing configuration related issues in production environment.
• Coordinate UAT for assigned projects. Drive UAT execution and resolution of identified Pricing configuration defects.
• Support Product Owner by tracking project progress, identifying risks, and communicating status to the business(es) and organizational leadership.
• Coordinate key requirement and UAT activities. Drive efforts and facilitate meetings. Partner with upstream and downstream stakeholders to ensure seamless and predictable outcomes.
• Other projects and duties as assigned.

• Mandatory Skills Description:

• Bachelor's degree in Computer Science, Business, Administration, Security, or related field or equivalent work experience.
• Typically, 5-7 years of relevant experience.
• Experience in Pricing configurations, Claims rule and healthcare government mandates.
• Experience in Blue Cross and Blue Shield payor is preferred.

Skills required:
• Business Analysis.
• In-depth understanding in Claims processing, Pricing configuration and understanding of technology.
• Experience in working in Service Now for managing tasks and request.
• MetaVance application knowledge.
• Experience working with specified deadlines and SLA(s)
• Organizational and multi-tasking skills
• Proficient in MS Excel.
• Strong communication skills.
• Agile methodology and framework.

• Nice-to-Have Skills:

• Working knowledge of MS Azure DevOps will a plus
• General understanding of related technologies.
• Customer Service General Project Management.