Technical Business Analyst (Claims/HRP)- W2

  • Posted 11 hours ago | Updated 11 hours ago

Overview

Remote
Depends on Experience
Contract - W2

Skills

Claims
HRP
EDI
Claims Testing

Job Details

Project Description:

This position is responsible for understanding stakeholder needs and business issues to be addressed in the Enrollment Applications. Collaborate with the Product owner to assess configuration, EDI Eligibility transactions data mapping, Open Enrollment process, Exchange (Affordable Care Act) processes. Understand Eligibility and Premium billing functions. Assess requirements associated with new input and output Eligibility feeds, define UAT scope/testing needs and validate results. Act as point of contact for release notes, requirements and test cases related to Open enrollment processes and enhancements. Work alongside business and technical teams to increase collaboration and optimize productivity and communication. Ensure requirements and solutions conform to departmental, corporate, industry and government standards as specified.
We are looking for a Claims Systems Technical Analyst that has hands on Testing experience that could run claims through the system for testing.
Healthcare Insurance experience on hand-on Claims Adjudication experience, configuration, and/or financial background - is a must

Responsibilities:

Contribute to software development projects by writing, testing, and debugging code, with an emphasis on complex and critical components.
Collaborate with team members to meet project requirements, actively participating in design and code reviews.
Provide technical expertise and support to team efforts, acting as a subject matter expert in specific domains.
Assist in solving complex technical challenges, researching and proposing solutions.
Participate in defining software requirements and specifications.
Debug and troubleshoot production issues, working closely with operations and support teams.
Contribute to the assessment and adoption of new technologies and best practices.
Mentor junior team members, providing guidance and knowledge sharing.
Basic Qualifications:
Bachelor's degree in a relevant field (i.e., Computer Science) or equivalent combination of education and experience
Typically, 5+ years of relevant work experience in industry, with a minimum of 2 years in a similar role years of relevant software engineering experience
Proficiency in 1 or more software languages and development methodologies
Strong programming and debugging skills
Familiarity with software development practices and methodologies
Strong problem-solving skills
Good team collaboration and communication abilities
Willingness to take ownership of complex technical challenges

Mandatory Skills Description:

Essential Job Functions:
HealthRules Payer (HRP) Experience
Healthcare Insurance experience on-hand, Claims Adjudication experience, configuration, and/or financial background
TA/BA/QA experience in an Agile Methodology or Waterfall project planning
Hands-on Testing experience
EDI transactional knowledge and ability to update or audit values: 837 and 835
Explanation of Payment knowledge/history, Financial or offset knowledge
HRP XML transaction knowledge
ITS system knowledge (Bluecard)

Nice-to-Have Skills Description:

Great communication skills

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