Configuration Director

Location: San Francisco, CA
As a Configuration Director you will play an active role in executing on a strategy that will enable Insurance Operations to scale efficiently to meet the demands of the organization. In addition, you will play a primary role in developing, managing, and scaling a team within Insurance Operations which includes integration with key business partners, systems analysis and configuration, monitoring, audit preparation, and testing for quality and accuracy. We are looking for a candidate with strong experience in health system implementations, operational configuration management (provider contract, claims and benefits), leading teams to high-quality outcomes, and has a strong conviction that health insurance can and should be better. The Configuration Director will conceptualize and drive execution of operational workflows, and logistics in a way that is iterative, data-driven, and with an eye towards technology-enabled scalability.

Title: Configuration Director
Location: San Francisco, CA
Job Type: Full-Time  

Job Duties:
  • Develop processes and controls to ensure that all business configurable data within the claims system is understood, configured and tested before being deployed into the production claims system.
  • Plan staffing and workloads effectively to ensure internal service levels are maintained during peak configuration seasons for benefits and provider contracts.
  • Develop and execute on a strategy to reduce avoidable errors within claims processing to drive a more positive provider and member experience.
  • Lead a team in building configuration processes from the ground up, including designing key configuration data and business logic.
  • Drive strategy of  claims system towards business goals: maximizing auto-adjudication and ensuring 100% claims processing accuracy.
  • Develop and maintain test cases and a testing framework to ensure accuracy through any configuration changes.
  • Interface across broader Operations teams to understand and prioritize improvement areas, and proactively drive changes that will increase team efficiency and accuracy.
  • Collaborate with Product Managers to develop and maintain key integrations between and across insurance systems.
  • Develop and maintain other related adjudication and eligibility configurations.
  • Develop a strategy to cross train staff to be proficient in multiple configuration disciplines (claims, provider contracts, benefits etc.).
Requirements:
  • You are a great communicator and able to communicate across different teams and upward to senior leadership. 
  • You are a strategic prioritize, and able to identify where and when to focus your energy.
  • You are a problem solver and like getting your hands dirty with the details of a gnarly problem.
  • You love data and using it to make metric-driven decisions.
  • You are passionate about healthcare and opportunities for improving the lives of insurance members.
  • You have 7+ years of relevant technical experience in health insurance software configuration or systems implementation.
  • You are an experienced team lead or have been a lead analyst within implementations.
  • You have experience working in provider, benefits and/or claims configurations.
  • You have a working knowledge of provider contracts and Medicare claims payment methodologies.
  • You have proven experience working with analytical tools. Major plus if you come with SQL skills.
 
 
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