• US Citizen

• Green Card

• Corp-Corp

• Consulting/Contract

• UG :- - Not Required

• PG :- - Not Required

• No of position :- ( 1 )

• Post :- 11th May 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.