Note: The job is a remote job and is open to candidates in USA. Conduent 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 lead the Claims Domain for MMIS health care projects, focusing on driving the claims module, performing business analysis, and ensuring quality processes.
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
Skills
- 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
- 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
Benefits
- Remote work: Enjoy the convenience of working from home and maximize your time by unplugging at the end of your workday.
- 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.
- Bonus or incentive
- Health insurance coverage
- Voluntary dental and vision programs
- Life and disability insurance
- A retirement savings plan
- Paid holidays
- Paid time off (PTO) or vacation and/or sick time
Company Overview
Company H1B Sponsorship