Senior Business System Analyst(Claims)

Qualifications
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12 years overall BA experience, with 4–6+ years specifically within the functional domain.
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Application design, development, maintenance, testing, implementation, and production support experience in a complex technology environment.
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Hands-on technical background with relevant platforms, programming languages, databases, job streams, interfaces, batch processing, reporting, or configuration tools used by the account.
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Experience serving as a lead developer, SME, workstream lead, technical coordinator, or TFAL.
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Ability to analyze complex technical and functional issues, evaluate alternatives, recommend practical solutions, and drive assigned work to completion.
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Ability to work effectively across business, technical, testing, operations, and client-facing teams.
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Sound knowledge and experience in the functional areas of claim, provider and member.
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Experience supporting claims-processing solutions, including claims adjudication, edits, audits, pricing, payments, denials, pending claims batch processing, operational impacts, financial impacts, and downstream reporting or interface dependencies.
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Experience supporting provider enrollment, credentialing, screening, provider maintenance, provider data management, provider workflows, provider portal functionality, and provider-related integrations.
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Experience supporting eligibility, enrollment, member maintenance, demographics, coverage, member data, member-related interfaces, correspondence, and downstream impacts to claims, reporting, and operations.
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Cross functional interaction between claim, provider and member
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Coordination with Claims, Provider, Reference Data / Configuration, Reporting, Interfaces, or Operations teams
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Healthcare IT, Medicaid, financial systems, claims, eligibility, provider, or similar large-scale government program experience