Claims Module Senior Business Analyst

Claims Module Senior Business Analyst

About the Role

This individual will play the role of Claims Domain lead for MMIS health care projects

Responsibilities

• Drive the claims module and process and provide domain knowledge
• Perform analysis of business requirements
• Design and develop documentation and ensure quality process while coordinating with customers.
• Work in a team environment and provide guidance throughout the entire life cycle.
• Responsible for meeting customer expectations and troubleshooting problems in the application.
• Assist customers in implementation decisions.

Requirements

• Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
• Candidate should have hands-on experience on claims processing and Adjudication processes.
• Must have good experience in Reference code/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 able to run queries and perform basic system analysis, RCA etc.,
• 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
• Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
• Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.

• In depth understanding of Claims and Claims lifecycle:

  Member, Provider, Claim submission – Paper and EDI X12, Adjudication, Payment Cycle (Finance), Reporting

• Claim Types: Professional, 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, 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

Preferred Skills:

• Minimum of 8+ years of experience in health care experience 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

Flexible Working

At Conduent, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone too.
In this role, you can expect the following working conditions:

Remote work: Enjoy the convenience of working from home and maximize your time by unplugging at the end of your workday.

Working For You

Perks and rewards designed for you:

• Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
• Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts.

Join Us

At Conduent, we are one team, one mission. We understand that our success is directly related to the success of our associates. We strive to create a culture where you can:

Bring your authentic self to work
Grow and thrive, both personally and professionally
Make a difference with our clients, in our communities, and with the millions of people we support

When you join Conduent, you are engaged in creating the future - both our company’s and your own. With more than 60,000 associates across 24 countries, we will provide you the opportunity to grow with a team of people who will challenge and inspire you to be the best!

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.