The Configuration Specialist of Core Systems will function as a subject matter expert on core business functions, processes, workflows, application configurations, and product support for the business units utilizing claims and eligibility software. In this role, the Specialist will demonstrate advanced technological, organizational, and leadership skills, and provide a collaborative conduit between the IT department, the business units, and the vendor support team. They will be responsible for the workflow design, data collection, configuration, testing, maintenance, and implementation of new requirements for the claims and eligibility software.
This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office (Morrisville, NC) may be required.
Responsibilities & Duties
Development, Configuration, and Support
- Responsible for configuration, data management, development of claims adjudication rules, workflows, and system parameters
- Supports the customization of system modules based on business requirements e.g. benefit plans, provider contracts, and fee schedules
- Supports the update of claim edits, code sets (ICD, CPT, HCPCS, NCCI), and other configurable elements
- Provides development and support activities for the application, including collaboration with business analysts, product owners, and stakeholders to understand claims processing needs for the purpose of translating business requirements into technical configuration specifications
- Reviews and participates in resolving issues with data loads, workflows, configurations, rule processing, etc.
- Analyzes proposed product design and configuration changes to determine the effect on the overall system and suggest appropriate alternatives and solutions
- Has an extensive understanding of the business unit's function and can effectively communicate technical issues and solutions in non-technical terms to the business unit
- Supports the configuration control process during product configuration, testing, and migration between environments, including business reviews and approvals
- Provides advice and guidance on methods, procedures, and requirements to individuals responsible for creating documentation
Support System Testing
- Write and perform unit end-to-end testing and debugging—set test conditions based on code specifications
- Able to analyze and debug complex data errors and provide resolutions as required
- Validate testing outcomes to ensure alignment with business rules, requested enhancements, and regulatory compliance
- Support User Acceptance Testing along with business users
System Maintenance and Optimization
- Monitor claims processing performance and investigate configuration-related concerns
- Identify and implement improvements to streamline claim workflows or increase accuracy
- Assist in System upgrades, patches, and releases
- Provide Tier 2 or Tier 3 support for configuration-related concerns escalated by the operations or system support teams
- Remain up to date on healthcare regulations (HIPPA, CMS etc.) or insurance rules to ensure configurations remain compliant
Documentation Development and Maintenance
- Maintain clear documentation of configuration changes, test results, and system setups
- Identify and document the functional and technical characteristics of the product configuration, provide the appropriate change control document, and report those changes
- Provide version control and documentation of all element migrations between the various Application environments
- Provide advice and guidance on methods, procedures and requirements to individuals responsible for the creation of documentation
Minimum Requirements
Education & Experience
Required:
High School diploma or equivalent and five (5) years of experience in application support, including experience planning, facilitating, eliciting, documenting and managing business, functional and technical requirements.
OR
Graduation from a Community College or Technical School with a two-year degree in computer science, information technology, information science, human services, healthcare, or related field and three (3) years of experience in application support, including experience planning, facilitating, eliciting, documenting and managing business, functional and technical requirements.
Preferred:
Bachelor’s degree from accredited university in an information technology or related field and five (5) years of experience in business application consulting or development, including experience in planning, facilitating, eliciting, documenting and managing business, functional and technical requirements.
Experience in Healthcare Insurance Claims, Encounters, or Enrollment processing and system configuration in an insurance or healthcare industry setting highly preferred.
Knowledge, Skills, & Abilities
- Knowledge of Software development and programming
- Knowledge of data analysis on databases/data sets
- Understanding of SDLC and Agile methodologies
- Keen understanding of IT system design processes
- Microsoft Office, Visio, Microsoft Project and Microsoft Visual Studio skills
- Excellent facilitation and organizational skills
- Strong critical thinking and problem-solving skills
- Excellent written communication skills, including technical writing and document design principles
- Ability to manage and work on multiple projects at the same time
- Ability to think independently and contribute to projects
- Strong leadership and people management skills, with the ability to inspire and motivate a team.
Employment for this position is contingent upon a satisfactory background check and credit check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.
Salary Range
$81,873-$104,388/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
