Solutions Specialist

POSITION SUMMARY
The Solutions Specialist is part of the Client Services Group and is responsible for delivering high -quality client solutions for ZeOmega’s care management platform.

This role works closely with client stakeholders, internal delivery teams, and technical resources to ensure successful implementation of enhancements, system optimization, integrations, and ongoing operational support for client environments.

The position primarily focuses on client services initiatives such as solution design, requirement analysis, configuration oversight, and client consulting, while also supporting production operations, issue resolution, and client escalations to ensure overall client success and platform stability.

ESSENTIAL FUNCTIONS

• Organize, define, and manage the work activities of Business Analysts and support team members across the Client Services Group.

• Establish and maintain strong relationships with client stakeholders and serve as a trusted advisor on system capabilities and operational improvements.

• Lead requirement gathering sessions with clients to understand business workflows and translate them into system configuration or enhancement requirements.

• Analyze current client business processes and identify opportunities for optimization through system configuration, automation, or workflow improvements.

• Work with clients to define future -state workflows for care management processes.

• Document functional requirements and oversee the preparation of functional specifications and solutions documentation.

• Lead client solution discussions related to configuration, integrations, reporting requirements, and system enhancements.

• Collaborate with project managers and internal teams to support delivery of enhancements, integrations, and system updates.

• Responsible for working on optimization reviews & analysis along with clinical consulting team.

• Perform client end user observations and deliver reports with recommended solutions and strategies addressing all client pain points.

• Collaborate with Business and support analysts and act as a client facing lead for the allocated clients.

• Coordinate configuration activities and oversee implementation of client requirements within the care management platform.

• Participate in release planning activities and coordinate client readiness for system releases.

• Validate software features and configuration updates to ensure alignment with approved requirements.

• Support user acceptance testing activities and coordinate testing efforts with business users.

• Provide subject matter expertise and guidance on healthcare compliance standards including NCQA, HEDIS, URAC, Medicare, and Medicaid processes.

• Provide solution demonstrations and system capability walkthroughs to clients.

• Support implementation of client reporting requirements and compliance reporting needs.

• Contribute to internal process improvements, delivery standards, and strategic initiatives within the Client Services Group.

• Provide ongoing support for client production environments including issue triage, troubleshooting, and resolution coordination.

• Monitor and manage client -reported issues and defects, coordinating with internal teams to ensure timely resolution.

• Serve as an escalation point for complex client issues requiring functional or operational analysis.

• Work with support analysts and technical teams to investigate defects and system issues and document resolution steps.

• Participate in post -release validation and ensure new features or fixes operate correctly within client environments.

• Provide guidance to clients on system usage, configuration adjustments, and best practices.

• Assist with root cause analysis for recurring issues and recommend corrective actions.

• Participate in operational support meetings and client status reviews.

• Contribute to improving support processes, knowledge documentation, and operational workflows.

SKILLS & ABILITIES

Other Requirements:

·        Successful implementation of Care Management IT applications.

·        Significant client -facing experience.

·        Strong attention to detail and ability to produce quality work individually and through others.

·        Familiarity with systems and data integration concepts.

·        Detailed understanding of healthcare coding, including CPT, HCPCS, ICD9, ICD10, DRG, and ERG.

·        Good understanding of automation of business processes in the healthcare industry.

·        Solid understanding of care management business processes - Utilization Management, Disease Management, Case Management, Wellness Management, Health Coaching, Member Services and Appeals.

·        Thorough understanding of products both at a business and technical level. Accountable to coordinate all technical design discussions with the client.

·        Clear understanding of the Build phase and Release process. Able to present and perform a walk -through of the Jiva release process to the client.

·        Good understanding of the claims adjudication process and dependencies on the authorized approval/denial process.

·        Ability to establish priorities, develop a course of action and a sequence of steps to ensure objectives are met.

·        Strong critical thinking and creative problem -solving skills; proven ability to succeed under pressure and navigate ambiguity with ease.