Senior Business Analyst – Claims module

Senior Business Analyst – Claims module:

Summary:

Play the role of Claims Domain lead for MMIS health care projects. Drive the claims module and process, domain knowledge, perform analysis of business requirements, designs and develop documentation, ensures quality process, coordinates with customers. Works in team environment and provides guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisions.

1. Should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
2. Should have hands-on experience on claims processing and Adjudication processes.

3. Must have good experience in Reference code/data sets required in Claims adjudication.

4. Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.

5. Should be able to run queries and perform basic system analysis, RCA etc.,

6. Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestones, track and close feedback from such demos

7. Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks

8. Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.

9. In depth understanding of Claims and Claims lifecycle:

• Member

• Provider

• Claim submission – Paper and EDI X12

• Adjudication

• Payment Cycle (Finance)

• Reporting

1. Claim Types:

• Professional

• Dental

• Institutional

• Pharmacy

• Encounters and Capitation

1. Claim Formats:

• EDI X12 formats like 837P/I/D

• X12 formats 835, 834, 270/271, 276/277

1. Claim System:

• Familiarity with systems like CMdS, GHS, Facets and etc

Technical Skills

• SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).

• EDI Tools: Validating X12 files.

• Interface Testing: Understanding how data flows between systems and formats and use tools like postman 

Required skills:

• Minimum of 8+ years of experience in health care especially in MMIS domain.

• Capability to think out-of-the-box to create new solutions as needed.

• Ability to validate Test scenarios and test plans, test data.

• Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)

• Should have excellent communication (written and spoken ) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.

• Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.

• Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented.

• Communication: Collaborate with cross-functional teams 

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information.  For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $85,470 - $111,000. 

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

For US applicants: People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by submitting their request through this form that must be downloaded:  click here to access or download the form.  Complete the form and then email it as an attachment to [email protected]. You may also click here to access Conduent's ADAAA Accommodation Policy.