Healthcare Claims Consultant

Business Analyst - Claims

Experience : 8-9 years

JD :

• Candidate must have worked in US healthcare with experience minimum of 8 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 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