Job Title: Business Analyst - Claims

Location: Bangalore

PRIMARY PURPOSE:

Based on assignment and under minimal direction of management, responsible for applying business knowledge and skills to assist, organize and coordinate projects, and support operations that will improve or enhance the administration of benefits through claims processing and other supporting functions that includes but is not limited to increasing the level of automation, problem identification and resolution, improving work-flows and procedures, develop and review reports, develop or revise appropriate documentation, and unit and system testing for all Lines of Business. You will perform a variety of multi-faceted tasks to include identification of issues and data collection, analysis and interpretation, and documentation to develop or substantiate internal and external business proposals. You will be assigned to lead and coordinate business projects of low to medium complexity.

QUALIFICATION REQUIREMENTS:

Required:

• 5 years related experience in Healthcare Payer industry or Health insurance
• 3 years related experience in Claims processing or Configuration support for Healthcare Payer or Health insurance
• Must have US Healthcare experience
• Basic knowledge of performing Claims analysis using SQL databases
• Experience on HealthEdge / HealthRules Payer (HRP) or FACETS or QNXT

ESSENTIAL DUTIES/FUNCTIONS:

1. Business Analysis:

• Gathers, reviews and analyzes Claims data to identify issues, and potential problems and solutions related to development and implementation, including but not limited to new products or services, contract deliverables, enhancements to add functionality and/or redesigns of systems, both manual and automated, to improve efficiency, financial models of costing and pricing.
• Utilize the data analysis skills and experience including but not limited to SQL queries to pull or download appropriate data or reports from processing systems required for the analysis
• Develops forward thinking, data driven recommendations and strategies that align with business objectives and based on logical assumptions and facts considering resources, constraints, and Employer values.
• Delivers critical pieces of analysis and research to drive new insights and actively and openly shares with appropriate parties to encourage collaboration for improvement and change. Translates analysis into solutions and/or options for consideration of specific actions, including business process improvements.
• Initiates change and evaluates impact. Plans and executes all initiatives for maximum impact but minimal disruption to our key stakeholders. Promotes and processes product efficacy – translates large volumes of data, testing and experiments into clear recommendations and responses to constantly changing business environments. Provides quality, objective, and professional analysis.

1. Guiding Project Team and Operational Units:

• Engages and collaborates with project staff and subject matter experts with the planning and implementation of project and sub project work efforts. Supplies or advises in the development of requirements, reports, budgets, and other analyses, and help solve operational issues and roadblocks.

1. Cross-Functional Integration and Communication:

• Engages closely with cross-departmental team members to complete tasks and provide status updates. Works with the project team, other departments and external partners to monitor, collect, communicate, and distribute information. Communicates analysis, assessments, recommendations and completed work product through professional written and verbal reports and presentations effectively and cross-functionally. Conducts presentations to all levels of the organization (unit meetings, department meetings, management meetings, etc.) to ensure reporting of quality outcomes are consistent and understood.
• Acts as a key liaison point for other departments and within Claims (e.g., Claims Production, IT, Configuration, etc.). Ensures cross-functional coordination and alignment.

Subtotal (a-c)

1. Business Testing:

• Coordinates testing needs and requirements with corporate testing unit.
• Support the Business testing or User acceptance testing as needed, including but not limited to lead and/or coordinate the testing activities which may include gathering and generating test data, identifying test scenarios, status reporting, escalating issues, and performing validation and approval of testing results.

1. Training and Development:

• Coordinates implementation within department, including but not limited to development of processing and procedure documentation, training materials and employee training as required.

INTERESTED CANDIDATES CAN DROP YOUR UPDATED RESUME TO BELOW WHATSAPP NUMBER OR EMAIL TO BELOW ID.

9884022260

[email protected]

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