93 applicants

Overview

Company

Original Job Post

Wipro · 1 week ago

Benefit Configuration Analyst

Tampa, FL

Full-time

Onsite

Mid Level

2+ years exp

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Responsibilities

Update and maintain benefit plans, provider contracts, fee timelines, etc.

Develop configuration standards and best practice guidelines to maintain accuracy, efficiency, and automation plus overseeing the integration with external and internal systems and/ or programs.

Perform system error root cause analysis and resolve benefit and pricing-related claims payment issues

Analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary.

Interpret specific state and/or federal benefits, contracts plus the business requirements then converting these terms to configuration parameters

Test, track and approve new system functionality and enhancements, Debug issues, providing timely fixes that include the development and execution of test plans and scripts

Conduct training sessions for new hires and existing team members covering benefit coding principles, Facets configuration guidelines.

Provide hands-on training sessions on the utilization of the Facets system for benefit configuration.

Conduct training needs assessments to identify gaps in knowledge and skills to ensure training throughput.

Familiarity with healthcare policies, regulations, and compliance requirements, such as HIPAA and ACA.

Proficiency in different types of health insurance plans, including HMOs, PPOs, and government-sponsored programs like Medicare and Medicaid.

Proficient in MS office including outlook, word, excel and power point.

Qualification

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HealthcareMedical InsuranceRelational DatabasesQuery ToolsStatistical SoftwareData ManipulationData AnalysisClaims ProcessingProblem-SolvingAnalyticalOrganizationalPresentation

Required

Bachelor’s degree and above

Currently live in the Tampa, Fl or Atlanta GA area

2 - 3 Years of experience in US Healthcare and in Benefit Configuration - Benefit coding / Auto Adjudication Set up processes and Quality testing.

Experience with medical plan benefit configuration using the Facets system /SQL and database experience with basic queries.

Excellent US Healthcare knowledge in Benefits coding and validation

Excellent communication skills and experience in working with US clients directly.

Ability to complete the assigned tasks on time, Understand the SLAs and ensure they are met.

Ability to coordinate with the Leads and Onshore in work prioritization and able to track and report self-work.

Ability to work independently with onshore/offshore team to deliver the assigned projects.