Junior System Configuration Specialist

During Training (Supervised Phase) Learn health insurance fundamentals, health plan terminology, reimbursement methodologies, and benefit structures.

Understand the end-to-end Operations lifecycle, including eligibility, provider networking, credentialing, configuration, claims, revenue, Provider Relations/downstream contracting, Payer Account Management, and customer service.

Shadow Senior Specialists during system loads and terminations of various types.

Navigate core systems, including CapAdmin, PDM, Epic, ePortal, the provider portal, and the Master Roster.

Perform basic configuration (Vendor, Location, Contract, Fee Schedule, Provider, Master Roster updates, and Fuel Surcharge) with source validation under the supervision of a Lead, Senior, or QA Specialist, for the following areas: Acupuncture, Chiropractic, Optometry, and Podiatry General Transportation and Ambulance Companies (ALS/BLS) ADC and PPEC Fuel Surcharge SN and NEMT terminations Perform basic configuration independently in the UAT environment to demonstrate competency, with QA review by a Lead, Senior, or QA Specialist.

Support benefit configuration activities.

Work Jira tickets assigned by the Lead or Senior Specialist; navigate the HPO Jira project and Configuration Dashboard.

Open Service Desk tickets as needed (IT, Epic Application Support, provider portal, etc.).

Review and revise own work before submitting to QA, and document all work appropriately.

Use available reference resources, ask thoughtful questions, and provide feedback on the training program.

Contribute to the development of the configuration manual.

Communicate with other teams as needed.

After Training (Independent Phase) Independently pick up and complete standard configuration tickets.

Perform benefit configuration, including copays, coinsurance, limits, exclusions, and authorization requirements.

Load and QA Fuel Surcharge updates.

Research basic configuration questions and perform basic troubleshooting.

Resolve routine configuration issues and routine claim suspensions.

Identify discrepancies and escalate to Lead or Senior Specialists as needed.

Maintain documentation standards, and continuously contribute to and update the configuration manual.

Perform other related duties as assigned.