Provider Application SME
simplify alphatmJacksonville, FL
About the role
Job Title: Provider Application SME (Technical)
Key Responsibilities: Onshore US Remote
Experience: 12 to 15 years
Summary:
We need a Provider Application Expert with hands-on build experience in Provider Data Management (PDM) and Provider Network/ Contracts applications. This role owns the technical design of provider data workflows, drives rules-based automation, and architects integrations across Claims, Provider Directory, Portal, and other downstream systems.
Key Responsibilities:
- Design, configure, and support Provider Data Management and Provider Contracts modules on the core admin platform, including provider onboarding, credentialing data, network/panel assignment, and contract term modeling
- Automate provider data business processes using rules engines (e.g., Drools, Kogito) and workflow/BPM configuration
- Architect and build upstream/downstream integrations with Claims adjudication, Provider/Member Portals, and Provider Directory systems using REST/SOAP APIs, message queues, or ETL pipelines
- Own data mapping and transformation logic between provider source-of-truth systems and downstream consumers (claims pricing, network adequacy, directory publishing)
- Implement and troubleshoot data integrations relevant to provider data (e.g., Provider data hierarchy, enrollment linkage where applicable)
- Build and maintain provider data quality rules: deduplication logic, match/merge algorithms, validation rulesets, and exception-handling workflows
- Support CI/CD-based config promotion across environments (dev/test/prod) for provider application changes
- Partner with delivery leads to translate business/functional requirements into technical specs, data models, and configuration artifacts
Required Technical SkillsHands-on development/configuration experience in Provider Data Management and Provider Contracts applications for Health plans with core admin platform integrations.
Strong understanding of provider data models: NPI/TIN structures, provider-to-contract-to-network relationships, roster/panel data, credentialing attributes
Integration development experience — REST/SOAP APIs, batch/file-based interfaces, or middleware (MuleSoft, Boomi, etc.) connecting to Claims, Portal, and Directory systemsSQL proficiency for data validation, troubleshooting, and reporting against provider data stores
Advantageous SkillsEDI transaction experience, and related provider/network transaction sets
Provider data quality tooling experience: match/merge, MDM platforms, or data governance frameworks
Contracts automation experience — rules-based contract term application, fee schedule automation, or rate configuration engines
Experience with rules engines such as Drools/Kogito for automating provider workflow logic
Familiarity with CI/CD pipelines for platform config promotion
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JOB OVERVIEW
Experience level
Lead
Location
Jacksonville, FL
Occupation
Software Developers
Industry
Custom Computer Programming Services
Posted
yesterday
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