New

Network Claims Configuration Processor

Aleron

Apr 28, 2025
Description Acara Solutions is looking for a Network Claims Configuration Processor for one of our clients in the Health Insurance Industry. $18/hr Contracted through 12/31/25 Fully Remote Overview The Network Configuration Processor shall be responsible to ensure that the reimbursement base is configured, implemented, and maintained in the claim payment systems (Healthrules) in support of the organization's objectives. This will include at a minimum, fee schedule build, contract build and set up, and providing feedback on options to implement. Essential Accountabilities Develop Hospital Contract Logic in core claims system. Interpret and implement negotiated contracts into core systems (DRG tables, fees, etc.). Ensure consistent, accurate and timely information is communicated to all concerned parties by coordinating activities with the claims and servicing departments. Create, load, maintain, edit rate tables, and fee schedules as necessary. Coordinate with claims department to ensure accurate adjudication using developed contract logic. Build/Change provider reimbursement file. Liaison to IHA claims department for Intergroup pricing. Intergroup provider verification set up. Validate Monthly Bases Loaded file and duplicate provider identification Audit Fee schedule changes. Develop and maintain SOP's on all responsibilities. Attend meetings as needed. Test all upgrades. Job Requirements Required Skills / Qualifications: High School diploma or GED required. At least 1 year of experience in network/provider operations and/or claims Preferred Skills / Qualifications: Working knowledge of high volume/system configuration environment preferred. Excellent communication and problem-solving skills required. Demonstrated ability to absorb and implement new concepts. Strong analytical skills and time management skills. Excellent verbal and written communication skills. Working knowledge of medical terminology. Ability to work with others in a team environment, using consultative decision -making techniques. Aleron companies (Acara Solutions, Aleron Shared Resources, Broadleaf Results, Lume Strategies, TalentRise, Viaduct) are Equal Employment Opportunity and Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity, sexual orientation, national origin, genetic information, sex, age, disability, veteran status, or any other legally protected basis. The Aleron companies welcome and encourage applications from diverse candidates, including people with disabilities. Accommodations are available upon request for applicants taking part in all aspects of the selection process. Applicants for this position must be legally authorized to work in the United States. This position does not meet the employment requirements for individuals with F-1 OPT STEM work authorization status. Apply