Junior Configuration Specialist

Alivi Health•Miami, FL

19h•Hybrid

About The Position

The Junior Configuration Specialist supports the Operations team by building and maintaining provider, contract, fee schedule, and benefit configuration across Alivi’s core systems. This entry-level role works under the guidance of Lead, Senior, and QA Specialists. It begins with structured training in health plan fundamentals, reimbursement methodologies, and the Operations lifecycle, then progresses to independently completing standard configuration tickets, resolving routine configuration issues and claim suspensions, and maintaining documentation standards. The position is suited to a detail-oriented professional seeking to build a career in healthcare operations and health plan configuration. During training, the specialist learns health insurance fundamentals, health plan terminology, reimbursement methodologies, benefit structures, and the end-to-end Operations lifecycle. The specialist shadows Senior Specialists, navigates core systems, performs supervised configuration and benefit support, and completes basic configuration independently in the UAT environment for QA review. They also work assigned Jira tickets, open Service Desk tickets as needed, review and document their work, contribute to the configuration manual, and communicate with other teams. After training, the specialist independently completes standard configuration tickets; performs benefit configuration, including copays, coinsurance, limits, exclusions, and authorization requirements; loads and QA-checks Fuel Surcharge updates; researches basic configuration questions; troubleshoots routine issues and claim suspensions; identifies discrepancies and escalates them as needed; and maintains and updates documentation and the configuration manual. Other related duties may be assigned.

Requirements

High school diploma or equivalent required.
Proficiency in Microsoft Office, especially Excel, including data entry, filtering, lookups, and validation.
Strong data-entry accuracy and ability to validate information against source documents.
Clear written and verbal communication skills.
Ability to learn multiple systems quickly and follow documented procedures.

Nice To Haves

Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field.
At least 1 year of experience in a healthcare, managed care, health plan, claims, provider data, or credentialing environment.
Exposure to provider, contract, fee schedule, or benefit configuration in a claims or health plan system.
Basic understanding of health insurance concepts and terminology, such as copays, coinsurance, fee schedules, and authorizations.
Familiarity with ticketing or work-management tools such as Jira or ServiceNow.

Responsibilities

Learn health insurance fundamentals, health plan terminology, reimbursement methodologies, and benefit structures during training.
Understand the end-to-end Operations lifecycle, including eligibility, provider networking, credentialing, configuration, claims, revenue, downstream contracting, payer account management, and customer service.
Shadow Senior Specialists during system loads and terminations.
Navigate CapAdmin, PDM, Epic, ePortal, the provider portal, and the Master Roster.
Perform supervised basic configuration and validate it against source documents for specified provider types, services, and terminations.
Perform basic configuration independently in the UAT environment for competency demonstration and QA review.
Support benefit configuration activities.
Work assigned Jira tickets and use the HPO Jira project and Configuration Dashboard.
Open Service Desk tickets as needed.
Review and revise work before submitting it to QA, and document work appropriately.
Use reference resources, ask questions, provide training-program feedback, and contribute to the configuration manual.
Communicate with other teams as needed.
Independently pick up and complete standard configuration tickets after training.
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 them 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.