Senior Business Analyst - Claims (Payer)

Job Role : Business Analyst - Claims (Payer)

Experience : 7-12 Years

Work Location: Chennai / Hyderabad

Work Model : Hybrid

Expectations : Looking for BA Functional candidates who worked in Claims specifically in US Healthcare Payer side.

Role Expectations:

• Candidate must have worked in US healthcare with experience minimum of 7 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 possessed 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 complex business problems and be 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 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
• Preferably to have basic SQL knowledge
• Soft spoken, thrive to learn and willing to work in flexible timing, and may require working on weekend as per business need