Business Analyst - Claims
Experience :8-9 years
JD:
- Candidate must have worked in US healthcare with experience minimum of 8 years, especially in claims application as business analyst or consultant
- Membership and provider domain knowledge/experience is preferable, but must have claims knowledge
- FEP, ITS (Interplan Teleprocessing system)/Blue card claims and B2 application knowledge/experience is preferable
- Work experience in EHR/EMR is also considered, but must have worked or possess knowledge of claims submission to Payers
- Should have knowledge in working with all types of claims medical, hospital, Pharmacy, Dental, Vision, Blue card/ITS etc
- Should have the fundamentals of requirement gathering, elicitation, documenting, and transition over to internal and external stakeholders
- Should have experience in writing functional specification documents/BRD
- Should have ability to solve the complex business problems and exposed to complete software development life cycle (SDLC)
- Should have sound knowledge in claims testing end to end, work under minimal supervision and take complete ownership of delivery
- Sound have knowledge of current US federal and state laws with regards to healthcare governance and policies, and preferable to have PAHM/FAHM certifications or working towards certification
- Business Analysis knowledge is mandatory, and preferable to have certifications like CBA/CBAP or working towards certification
- Nice to have work exposure with agile and scrum teams
- Preferable to have basic SQL knowledge
- Soft spoken, thrive to learn and willing to work in flexible timing, and may require to work on weekend as per business need
