Job Description
Senior Business Analyst
Responsibilities:- Play the role of Claims Domain lead for health care projects.- Drive the claims module and process, ensuring quality and coordination with customers.- Perform analysis of business requirements, design and develop documentation.- Meet customer expectations, troubleshoot problems in the application, and assist customers in implementation decisions.- Work in a team environment and provide guidance throughout the entire life cycle.- Conduct demos at completion of milestones and track feedback from such demos.- Collaborate closely with development, architecture, and design teams to define GUI view and platform requirements.
Required Skills:- Strong health care domain experience with good knowledge of Medicaid and Medicare.- Hands-on experience in claims processing and adjudication processes.- Experience with sets required in claims adjudication.- Prior experience or understanding in configuring benefits or programs in claims systems across various sub-systems.- Ability to run queries and perform basic system analysis and root cause analysis.- Excellent written and spoken communication skills.- Ability to multitask between internal teams and clients based on priority tasks.- In-depth understanding of claims and claims lifecycle, including member, provider, claim submission, adjudication, payment cycle, and reporting.- Familiarity with claim types (professional, dental, institutional, pharmacy) and claim formats (EDI X12 formats like 837P/I/D, 835, 834, 270⁄271, 276⁄277).- Familiarity with claim systems like CMdS, GHS, Facets, etc.
Technical Skills:- Proficiency in SQL for validating data in backend tables.- Experience with EDI tools for validating X12 files.- Understanding of interface testing and data flow between systems using tools like Postman. Preferred Skills:- Minimum of 8+ years of experience in health care, especially in the MMIS domain.- Capability to think creatively to develop new solutions as needed.- Ability to validate test scenarios, test plans, and test data.- Experience in reviewing requirements, documentation, and creating Requirements Traceability Matrix (RTM).- Excellent communication skills to engage with various stakeholders, including QA/dev teams, clients, end users, and business units.- Ability to assess current product functionality against market trends and regulatory requirements for future versions.- Ability to drive and share requirements with technical teams regarding product features to be implemented.
