MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Benefit Configuration Analyst will be responsible for constructing the Claims Processing Systems to process new enrollments. Experienced candidates must demonstrate working understanding of claims processing systems and working knowledge of the health care industry.

• Create and maintain Core Systems user guide related to configuration changes.
• Test system modifications and configuration changes.
• Analyze business process to improve efficiencies.
• Create templates on benefits to track current configuration.
• Ensure system processes and services are aligned with the department’s need.
• Analyze the system to ensure claims are processed correctly to prevent the company from liabilities.
• Collaborate with MetroPlusHealth system consultants to correct errors, rectify omissions, and investigate questionable issues.
• Identify potential system problems for claims resolution.
• Analyze business processes, gather the requirements, and document the requirements in line with the strategic initiative
• Review test cases making sure they are in accordance with requirements and assist the overall testing process.
• Conduct ongoing reviews of systems and processes to ensure accurate and optimum setup for claims.
• Attend meetings with managers regarding process plans, functionality, and business processes.
• Receive, coordinate, and manage requests for Systems Modifications
• Maintain and track open issues and coordinate releasing testing
• Document policies and procedures
• Ability to run reports utilizing sequel
• Monitor and Manage Core Systems performance
• Respond to escalated issues from various MetroPlusHealth Departments.
• Perform and assist with any other functions as required by the Director of Core Systems Operations
• Participate in special projects as needed.

• A Baccalaureate Degree from an accredited college or university; and
• Five (5) years of progressive, responsible experience in configuration for data processing, computer systems and applications; or
• A satisfactory equivalent combination of training, education and experience.

Professional Compentencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication