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Configuration Architects

Location: Remote

Description:  The Configuration Architects will be responsible for designing, implementing, and optimizing claims, benefit, and pricing configuration processes and systems within our organization. This role requires a deep understanding of claims, benefit, and pricing management workflows, data architecture, and system integrations. The architects will collaborate with various stakeholders to ensure configuration aligns with business objectives and regulatory requirements. They would assist with migrating our duals plans to a new Amisys instance and improving/rearchitecting the way we process these claims

Responsibilities:

• Design & Development:
• Develop and maintain a comprehensive claims, benefit, and pricing configuration strategy that enhances system capabilities and supports business needs.
• Design and configure claims, benefit, and pricing processing workflows in accordance with best practices.
• (Benefits)Develop and implement strategies for configuring claims systems to effectively manage benefit plans, coverage details, and eligibility criteria.
• (Benefits) Design workflows that ensure smooth processing of claims based on the defined benefits.
• (Pricing) Develop and implement pricing strategies and models that align with organizational goals and market standards.
• (Pricing) Design and configure the claims management system to accurately reflect pricing rules, fee schedules, and reimbursement methodologies.
• System Integration:
• Collaborate with IT and software development teams to ensure seamless integration of claims systems with other enterprise applications.
• Serve as a key point of contact between business units and IT teams, facilitating effective communication and understanding of claims processes.
• Evaluate and implement new technologies that improve claims processing efficiency.
• Stakeholder Collaboration & Engagement:
• Work closely with claims operations, product management, and compliance teams to gather requirements and translate them into functional configurations.
• Serve as a liaison between business units and technical teams to ensure effective communication and understanding of claims processes.
• Documentation & Training:
• Create and maintain comprehensive documentation for claims, benefit, and pricing configuration processes and system architectures.
• Develop training materials and conduct training sessions for users on new system functionalities and best practices.
• Monitoring & Optimization:
• Monitor system performance and user feedback to identify areas for improvement.
• Implement enhancements and updates to claims, benefit, and pricing configurations based on evolving business needs and regulatory changes.
• Compliance & Risk Management:
• Ensure that claims, benefit, and pricing configuration processes comply with industry regulations and internal policies.
• Assess and mitigate risks associated with claims processing systems.
• Ensure pricing configurations comply with relevant regulations and industry standards, including Medicare, Medicaid, and commercial insurance guidelines.

Experience and Skills:

• Minimum of 5-7 years of experience in claims processing, configuration, or a related role within the insurance or healthcare industry
• Proven experience with claims management systems (Amisys) and related technologies (DST, Optum Pricers)
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Ability to manage multiple projects and priorities in a fast-paced environment.
• Ability to collaborate effectively with cross-functional teams.
• Familiarity with data modelling, system integration, and workflow automation