The Junior Configuration Specialist supports the Operations team by accurately building and maintaining provider, contract, fee schedule, and benefit configuration across Alivi's core systems. Working under the guidance of Lead, Senior, and QA Specialists, this entry-level role begins with a structured training program covering health plan fundamentals, reimbursement methodologies, and the full Operations lifecycle, and progresses to independently completing standard configuration tickets, resolving routine configuration issues and claim suspensions, and maintaining documentation standards. This position is ideal for a detail-oriented professional looking to build a career in healthcare operations and health plan configuration. | |
During Training (Supervised Phase)- Learn health insurance fundamentals, health plan terminology, reimbursement methodologies, and benefit structures.
- Understand the end-to-end Operations lifecycle, including eligibility, provider networking, credentialing, configuration, claims, revenue, Provider Relations/downstream contracting, Payer Account Management, and customer service.
- Shadow Senior Specialists during system loads and terminations of various types.
- Navigate core systems, including CapAdmin, PDM, Epic, ePortal, the provider portal, and the Master Roster.
- Perform basic configuration (Vendor, Location, Contract, Fee Schedule, Provider, Master Roster updates, and Fuel Surcharge) with source validation under the supervision of a Lead, Senior, or QA Specialist, for the following areas:
- Acupuncture, Chiropractic, Optometry, and Podiatry
- General Transportation and Ambulance Companies (ALS/BLS)
- ADC and PPEC
- Fuel Surcharge
- SN and NEMT terminations
- Perform basic configuration independently in the UAT environment to demonstrate competency, with QA review by a Lead, Senior, or QA Specialist.
- Support benefit configuration activities.
- Work Jira tickets assigned by the Lead or Senior Specialist; navigate the HPO Jira project and Configuration Dashboard.
- Open Service Desk tickets as needed (IT, Epic Application Support, provider portal, etc.).
- Review and revise own work before submitting to QA, and document all work appropriately.
- Use available reference resources, ask thoughtful questions, and provide feedback on the training program.
- Contribute to the development of the configuration manual.
- Communicate with other teams as needed.
After Training (Independent Phase)- Independently pick up and complete standard configuration tickets.
- 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 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.
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Education & Experience- High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
- 1+ year of experience in a healthcare, managed care, health plan, claims, provider data, or credentialing environment preferred.
- Exposure to provider, contract, fee schedule, or benefit configuration in a claims or health plan system is a plus.
Knowledge & Skills- Basic understanding of health insurance concepts and terminology (e.g., copays, coinsurance, fee schedules, authorizations) preferred.
- Proficiency in Microsoft Office, especially Excel (data entry, filtering, lookups, and validation).
- Familiarity with ticketing or work-management tools such as Jira or ServiceNow is a plus.
- 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.
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