Benefits and Pricing Configuration Specialist

3 days ago


Hyderabad, Telangana, India beBeeBenefits Full time ₹ 12,00,000 - ₹ 20,16,000
Job Description

About the Position:

Our organization is seeking an experienced Analyst to join our team in configuring benefits and pricing structures within the Facets platform. The ideal candidate will have deep expertise in provider contracting, claims adjudication, and benefit/pricing plan setup.

The successful candidate will possess a strong understanding of the healthcare domain and hands-on experience with benefit/pricing and network configuration within the Facets platform. Key responsibilities include:

  • Configuring and maintaining benefit/pricing structures within the Facets platform.
  • Setting up and managing NetworX Pricer, Benefit Plans, and related configuration components.
  • Collaborating with Provider Contracting teams to translate business rules into system configuration.
  • Analyzing and supporting Claims Adjudication processes related to benefits or pricing discrepancies or escalations.
  • Ensuring compliance with Medicare, Medicaid, and commercial payer guidelines.
  • Participating in testing and validation of benefits or pricing setups to ensure accurate claim outcomes.

For success in this role, you will need:

  • A bachelor's degree in Engineering or equivalent qualification with minimum 3-6 years of relevant hands-on experience in benefits and pricing configurations.
  • Strong knowledge in API testing and EDI 278 transactions.
  • Hands-on experience in SQL database testing.


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