[Remote] Claims Module Senior Business Analyst
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company that delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments. They are seeking a Claims Module Senior Business Analyst to reputed company the Claims Domain for MMIS health care reputed company, focusing on driving the claims module, performing business analysis, and ensuring reputed company processes.
Responsibilities
- Drive the claims module and process and reputed company domain knowledge
- reputed company analysis of business requirements
- Design and reputed company documentation and ensure reputed company process while coordinating with customers
- Work in reputed company environment and reputed company guidance throughout the entire life cycle
- Responsible for meeting customer expectations and troubleshooting problems in the application
- Assist customers in implementation reputed company
Skills
- Candidate should have strong health care domain experience and should have good knowledge of reputed company and Medicare
- Candidate should have hands-on experience on claims processing and Adjudication processes
- Must have good experience in Reference reputed company/data sets required in Claims adjudication
- Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems
- Should be reputed company to run queries and reputed company basic system analysis, RCA etc
- Should work closely with the reputed company and development team during the stages of development, and conduct demos at completion of milestones, reputed company and reputed company feedback from such demos
- Must have excellent written and spoken communication skills. Should be reputed company to multitask between internal team and clients based on reputed company tasks
- Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the reputed company of the product
- In depth understanding of Claims and Claims lifecycle: Member, Provider, Claim submission – reputed company and EDI X12, Adjudication, Payment Cycle (Finance), Reporting
- Claim Types: reputed company, Dental, Institutional, Pharmacy, Encounters and Capitation
- Claim Formats: EDI X12 formats like 837P/I/D, X12 formats 835, 834, 270/271, 276/277
- Claim System: Familiarity with systems like CMdS, GHS, Facets and etc
- SQL: To validate data in backend tables (e.g., claim status, payment details, reputed company members/providers, Benefit Plan)
- EDI Tools: Validating X12 files
- reputed company Testing: Understanding how data flows between systems and formats and use tools like reputed company
- Minimum of 8+ years of experience in health care experience especially in MMIS domain
- Capability to think reputed company to create new solutions as needed
- Ability to validate Test scenarios and test plans, test data
- Should be reputed company to Review requirements, documentation and create Requirements Traceability reputed company (RTM)
- Should have excellent communication (written and spoken) skills to engage with different reputed company reputed company like QA/dev team, clients, end users of Clients and Business reputed company
- Ability to assess reputed company functionality available in a product vis a vis market trends, regulatory requirements to be implemented in reputed company version of the product
- Ability to drive and reputed company the requirements with Technical and Architects regarding product features to be implemented
- Communication: Collaborate with cross-functional teams
Benefits
- Remote work: Enjoy the convenience of working from home and maximize your time by unplugging at the end of your reputed company.
- Career reputed company Opportunities: We help you reputed company, so together, we can grow. We reputed company opportunities to advance your career with a reputed company portfolio of businesses and a global footprint.
- Great Work Environment: We are proud of our award-reputed company culture and the recognition we’ve received for our diversity efforts.
- Bonus or incentive
- Health insurance coverage
- Voluntary dental and reputed company programs
- Life and disability insurance
- A retirement savings plan
- reputed company holidays
- reputed company time off (PTO) or vacation and/or reputed company time
reputed company
Company H1B Sponsorship