BA healthcare Payer CLM

Ability Gather, analyse, and document business and technical requirements for healthcare Programs

Experience on core business applications in Enrolment, Claims. Payment areas (Facets, QNXT , NASCO etc )

Knowledge of CMS rating standards (STAR) and quality measures reporting

Ability to Interpret and map HIPAA X12 EDI transaction sets (e.g., 270 / 271, 837, 835, 999) to system data models and ITX transformations.

Conduct gap analysis, impact analysis, and facilitate design walkthroughs with business and technical teams.

Collaborate with QA teams to define test scenarios, acceptance criteria, and assist in defect triage.

Coordinate across cross-functional teams (product, ops, compliance, providers) to ensure integration requirements are met.

Skills Required

Test Scenarios, Facets, Gap Analysis, Impact Analysis, Star, Qnxt