Business Configuration Solutions Analyst, Associate - Hybrid

Role overview

Responsibilities

• Administer, configure, test, audit, and implement transactional claims processes for internal clients and TPA business.
• Model business requirements for new dental and vision products and design systems or enhancements for product administration.
• Use data analysis and research to identify client-satisfaction concerns and propose solutions.
• Validate system fixes, enhancements, and vendor upgrades.
• Research trends and produce incident and utilization reporting.
• Configure new dental and vision plans and audit requests against plan designs, schedules of benefits, and reimbursement requirements.
• Help design and implement competitive, actuarially sound dentist reimbursement models; maintain fee schedules across commercial, Medicare, and Medicaid lines.
• Generate utilization, network, inventory, vendor-oversight, and ad hoc reports.
• Provide reimbursement data and resolve claims issues involving rates, pending claims, manual pricing, and process efficiency.
• Maintain source-data dictionaries and handle adjustments, inquiries, reporting, and analysis.
• Collaborate with partners and vendors on technical strategies, requirements, and functional designs.
• Create and modify test plans, participate in work groups, and contribute ideas to support client satisfaction and teamwork.

Qualifications

• Bachelor’s degree or equivalent work experience.
• At least 4 years of general business experience.
• Understanding of XML data structures.
• Basic SQL statement knowledge.
• Act 34 is listed under licensure, certifications, and clearances.

Work arrangement

• Hybrid position consisting of work from home and work in the office in Pittsburgh, Pennsylvania.

Compensation

• Advertised pay range is USD 27–48 per hour.