Virtual Software System Specialist

Job Summary

This position performs elements of configuration, maintenance, testing, and troubleshooting of the core system used by TPA Services (e.g., VBA). Executes tasks as assigned for implementation, documentation and testing for all authorized configuration requests, including new workflows, enhancements to existing workflows, codes, product upgrades and new releases. Assists with training for product enhancements and upgrades. Works collaboratively with users in problem-solving issues related to the core system.

• Using knowledge of the core system and business unit operations, assists with configuration activities, while promoting efficient systems and operations processes. Provides ongoing support for assigned key applications - monitoring performance, documenting problems/resolutions, communication and serving as a resource for internal end users.
• Documents and implements policies, procedures, and workflow processes, working closely with the Systems Administrator on improving workflows and processing efficiencies. Participates in ongoing departmental education, training and productivity enhancement.
• Responsible to assist with VBA product upgrades and configuration; including testing, documenting and deploying requested configuration changes as directed by the Systems Administrator.
• Assists with the set-up of all code tables and configuration activities in VBA.
• Acts as a tier one technical resource for claims department in resolving payment issues involving setup or codes.
• Researches issues and evaluates findings, monitors ongoing performance, and communicates expectations and results.
• Documents problems and resolutions.
• Maintains an organized and automated historical file of all enhancements and/or changes in the core system administration and system configuration.
• Analyzes and interprets data for the purpose of identifying new knowledge or opportunities for improvement, making recommendations to the System Administrator based on these findings.
• Provide training of the system, website, mobile app and reporting program to both external and internal individuals.
• Identifies and researches specific business and operations data/information sources, reports, and analysis as directed and/or assigned.
• Maintains a detailed understanding and working knowledge of the current TPA core system.
• Functions daily with high-level confidential proprietary information, recognizing sensitive situations/discussions/materials, maintaining total confidentiality, without exception.
• Ensures adequate testing and validation has occurred before any changes are submitted for move into production, moving validation changes into production according to established policies and procedures.
• Maintains current knowledge of applicable federal and state laws, rules, and standards that apply to group benefit coverage, including health maintenance organization and insurance company state regulations related to PHP products.
• Participates in training on federal and state regulations applicable to position, and adheres to same.
• Participates in company-wide and departmental quality management activities.
• Performs any relevant and related duties as required.

Preferred

• Associate's Degree or equivalent
• An Associates Degree in Business or technology (or a related field).
• 2 years of relevant experience in the field. Preferred
• Two to three (2-3) years of experience, preferably within a TPA environment.
• A thorough knowledge of claims processing, information systems technology, and report design.
• Highly developed problem-solving skills within a multi-function setting.

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope.

Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location
SITE - 1700 Magnavox Way Suite 201 - Fort Wayne

Department Name
Physicians Health Plan of Northern Indiana Admin - PH Managed Benefits

Employment Type
Full time

Shift
Day (United States of America)

Weekly Scheduled Hours
40

Hours of Work
8:00 a.m. to 5:00 p.m.

Days Worked
Monday to Friday

Weekend Frequency
N/A

Corewell Health is committed to equal employment opportunity. We support…