Technical Lead

Infinite

6 - 8 years

8 - 10 Lacs

bengaluru

Posted:3 days ago| Platform:

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Skills Required

automation manager quality assurance claims analytical cms healthcare workflow actuarial continuous improvement testing

Work Mode

Work from Office

Job Type

Full Time

Job Description

Configure, maintain, and validate ISNP plan structures in Plexis: benefit tiers, member cost-share (crossover subsidies, wrap-around benefits), enrollment effective dates, dual-eligible plan identifiers.
Manage configuration team : assign Plexis setup tasks, monitor timelines, review outputs, coach specialists.
Testing Quality Assurance : Develop and execute UAT scripts specific to ISNP (e.g., dual tracking, auto-enrollment from Medicaid, cost-sharing overrides), ensure configuration integrity across Plan Benefit Package (PBP) cycles.
Cross-functional engagement : Work with care coordination, dual teams, IT, actuarial, compliance in particular ensure Plexis settings meet CMS and state Medicaid overlay rules, integrate rate cells and wraps properly.
Change documentation and version control : Track configuration changes across PBP years, maintain version history in Plexis and documentation repository.
Reporting/Monitoring : Generate dashboards showing configuration completeness, configuration errors logged, claims denial patterns tied to config; share insights to reduce configuration-related delays or denials.
Continuous improvement : Identify automation or workflow improvements in Plexis configuration; remain current on SNP regulatory updates (e.g., CMS guidance on dual eligibility, Medicare envelopes).
Compliance : Ensure Plexis-configured rules align with CMS, Medicaid, HEDIS, DE functional requirements.

Qualifications Revised:

Bachelors degree (Healthcare Admin, Business, IT) or equivalent. Continued professional growth in SNP regulatory, configuration best practices encouraged.
6 8 years of health plan operations or configuration experience preferably with 1 3 years managing Plexis or similar system, especially in Medicare or SNP contexts.
Must have direct experience with Plexis (or similar), configuring ISNP or dual-eligibility plan templates, cost-share overrides, state federal rules overlays.
Skilled in UAT test design, issue tracking, resolution, configuration QA.
Strong leadership background, cross-functional team coordination, vendor liaison.
Analytical, detail-oriented, excellent communication.
Tech-savvy: Plexis system, MS Excel (lookups ulas), project tracking tools, QA/test platforms.

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