Configuration Specialist-Core Systems; Remote, North Carolina

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…