Professional, Operations Configuration Tester

MVP Health Care

3d•Remote

About The Position

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.

Requirements

An associate’s degree or equivalent combination of education and related experience
The availability to work full-time, virtual within New York State.
Two years’ experience testing/auditing health care claims, provider data or configuration preferred.
Five or more years’ experience processing medical claims in lieu of previous auditing/testing experience.
Experience working with Word, Excel and Database Query Tool.
Excellent written and verbal communication skills, including the ability to facilitate meetings including those with external partners.
Able to coordinate activities among multiple groups for external testing.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction

Responsibilities

Responsible for the accurate and timely testing of configuration required to accommodate systematic provider reimbursement, adjudication rules and benefit plan requirements in Facets.
Responsible for the interpretation of requests, development of test plan, test strategies, solutions, and file creation in support of efficient and accurate claim adjudication.
Responsible for the coordination and delivery of testing results to external provider groups as required for project implementations.
Maintains detailed documentation related to work assignments to support audit processes including test plans, test case scenarios and detailed test scripts.
Develops and executes queries to support the testing of configuration, adjudication rules and benefit plan designs.
Identifies, tracks, and communicates configuration defects.
Creates claim reports related to work assignments that will be shared within Operations Claims for validation.
Collaborate with internal partners to understand configuration requirements needed to successfully validate benefit plan designs.
Responsible for timely investigation and resolution of claim review inquiries from internal customers.
Prepare detailed analyses and reports for internal customers when necessary.
Follow existing procedures and participates in root cause analysis meetings.
Recommends and implements process improvements.
Provides support in the development, improvement and automation of testing and QC processes.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.