Business Analyst (US healthcare - Claim Processing)

Business Analyst - Claims

Experience: 8-9 years

Job Description:

Candidate must have worked in US healthcare with experience minimum of 8 years of experience, especially in claims application as a 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