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Senior Business Analyst – Claims Module

TekShapers

Remote • Today

Easy Apply

Contract

Depends on Experience

Senior SAS Business Analyst with Medicaid/Claims experience (Remote)

Cleo Consulting Inc.

Remote • Yesterday

Easy Apply

Contract, Third Party

$55 - $60

Senior Business Analyst - Unemployment Insurance Benefits

eSystems, Inc.

Remote • 8d ago

Easy Apply

Full-time

Depends on Experience

Senior Auto Claims Adjuster

Strategic Staffing Solutions

Phoenix, Arizona • Today

Easy Apply

Full-time, Contract

USD37 - USD37

Business Analyst(Claims/Healthcare)

SoftPath Technologies LLC

Minnetonka, Minnesota • Today

Easy Apply

Full-time, Third Party

Depends on Experience

Senior Healthcare Business Analyst

Infinite Solutions Inc.

Remote • 6d ago

Easy Apply

Third Party, Contract

Depends on Experience

Claims Support Rep III

SANS

Hybrid in Sun Prairie, Wisconsin • Yesterday

Easy Apply

Contract

$20+

100% Remote Senior Business Analyst with Strong PBM / Health Plan

DMS Vision Inc.

Remote • 23d ago

Easy Apply

Contract, Third Party

Depends on Experience

Senior Guidewire Business Analyst

Envision Technology Solutions

San Antonio, Texas • 8d ago

Easy Apply

Full-time

Medicaid Claims QA Analyst(Healthcare)

Infinite Computer Solutions (ICS)

Remote • 17d ago

Easy Apply

Full-time

$85,000 - $95,000

CareFirstBridge/FEP Claims Tester - Remote -Contract

Lorven Technologies, Inc.

Remote • 16d ago

Easy Apply

Third Party, Contract

$55 - $60

California Workers Compensation Claims Examiner

Apidel Technologies

Remote • Today

Easy Apply

Contract

50 - 55

Senior Workers Compensation Claims Examiner - Remote / Telecommute

Cynet Systems

Rancho Cucamonga, California • Today

Easy Apply

Third Party, Contract

Depends on Experience

Senior Workers Compensation Claims Examiner - Remote / Telecommute

Cynet Systems

Los Angeles, California • Today

Easy Apply

Contract, Third Party

Depends on Experience

FACETS Architect (with Healthcare Claims)

Mindlance

Remote • Yesterday

Easy Apply

Contract

$80 - $90

Senior SIU Analyst / Fraud Analyst / Healthcare Domain Only

DVI Technologies, Inc.

Remote • Today

Easy Apply

Contract

45 - 50

Senior Business Systems Analyst

GDH

Remote • 13d ago

Easy Apply

Third Party, Contract

Depends on Experience

On-Site Senior Database Analyst (Data analysis/visualization/manipulation/ SQL/SAS/Python/Power BI/Tableau/Medicaid managed care, long-term services and supports (LTSS)

Global Information Services

Tallahassee, Florida • 7d ago

Easy Apply

Third Party, Contract

Depends on Experience

Solution Architect, Claims (Fraud & Leakage)

VDart, Inc.

Remote • 2d ago

Easy Apply

Third Party, Contract

$70 - $75

Epic Systems Professional Billing/Claims Analyst

Empower Professionals

Remote • Today

Easy Apply

Third Party, Contract

Depends on Experience

Senior Manager, Full Stack Development Python / Go / Java, AWS (Healthcare Claims)

Bramkas Inc.

Remote • 3d ago

Easy Apply

Full-time

Depends on Experience

Healthcare Claims SME, Remote - 70853

PRIMUS Global Services Inc.

Remote • Today

Easy Apply

Contract

$40.00 - 43.00

Business Analyst Claims, Payment Integrity, Data Analytics | Hybrid - 70854

PRIMUS Global Services Inc.

Minneapolis, Minnesota • Today

Easy Apply

Contract

HB/PB Claims Analyst

Randstad Digital

Minneapolis, Minnesota • Today

Contract

USD21 - USD31

HB/PB Claims Analyst

Randstad Digital

Minneapolis, Minnesota • Today

Contract

USD21 - USD31

Insurance Claims Change Manager

Perennial Resources International

Chicago, Illinois • 14d ago

Easy Apply

Contract

85 - 95

Data QA Engineer With Payer / Provider / Claims

Magicforce

Remote • Today

Easy Apply

Contract, Third Party

Depends on Experience

ETL Test Engineer-Healthcare (Medicaid Claims Processing)

ClifyX

Hybrid in East Hartford, Connecticut • Today

Easy Apply

Contract, Third Party

Depends on Experience

Claims Examiner

Symbioun Technologies, Inc

New Haven, Connecticut • Yesterday

Easy Apply

Contract

Depends on Experience

Transactional Liability Claims Counsel

SANS

Remote • Today

Easy Apply

Full-time

Depends on Experience

Job Details

Skills

Healthcare Claims
EDI
X12
MMIS
BA
Agile

Summary

Role : Senior Business Analyst – Claims Module

Location : Remote with travel

Type : Contract to Hire

Senior Business Analyst – Claims module:

Play the role of Claims Domain lead for MMIS health care projects. Drive the claims module and process, domain knowledge, performs analysis of business requirements, designs and develops documentation, ensures quality process, coordinates with customers. Works in team environment and provides guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisions.

Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
Candidate should have hands-on experience on claims processing and Adjudication processes.
Must have good experience in Reference code/data sets required in Claims adjudication.
Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
Should be able to run queries and perform basic system analysis, RCA etc.,
Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
In depth understanding of Claims and Claims lifecycle:

Member
Provider
Claim submission – Paper and EDI X12
Adjudication
Payment Cycle (Finance)
Reporting

Claim Types:

Professional
Dental
Institutional
Pharmacy
Encounters and Capitation

Claim Formats:

EDI X12 formats like 837P/I/D
X12 formats 835, 834, 270/271, 276/277

Claim System:

Familiarity with systems like CMdS, GHS, Facets and etc

Technical Skills

SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
EDI Tools: Validating X12 files.
Interface Testing: Understanding how data flows between systems and formats and use tools like postman

Preferred skills:

Minimum of 8+ years of experience in health care experience especially in MMIS domain.
Capability to think out-of-the-box to create new solutions as needed.
Ability to validate Test scenarios and test plans, test data.
Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)
Should have excellent communication (written and spoken ) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented.
Communication: Collaborate with cross-functional teams

Tekshapers is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10335759
Position Id: 30282-17456-1792075077
Posted 3 hours ago

Fitment

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Job Details

Skills

Healthcare Claims
EDI
X12
MMIS
BA
Agile

Summary

Role : Senior Business Analyst – Claims Module

Location : Remote with travel

Type : Contract to Hire

Senior Business Analyst – Claims module:

Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
Candidate should have hands-on experience on claims processing and Adjudication processes.
Must have good experience in Reference code/data sets required in Claims adjudication.
Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
Should be able to run queries and perform basic system analysis, RCA etc.,
Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
In depth understanding of Claims and Claims lifecycle:

Member
Provider
Claim submission – Paper and EDI X12
Adjudication
Payment Cycle (Finance)
Reporting

Claim Types:

Professional
Dental
Institutional
Pharmacy
Encounters and Capitation

Claim Formats:

EDI X12 formats like 837P/I/D
X12 formats 835, 834, 270/271, 276/277

Claim System:

Familiarity with systems like CMdS, GHS, Facets and etc

Technical Skills

SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
EDI Tools: Validating X12 files.
Interface Testing: Understanding how data flows between systems and formats and use tools like postman

Preferred skills:

Minimum of 8+ years of experience in health care experience especially in MMIS domain.
Capability to think out-of-the-box to create new solutions as needed.
Ability to validate Test scenarios and test plans, test data.
Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)
Should have excellent communication (written and spoken ) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented.
Communication: Collaborate with cross-functional teams

Dice Id: 10335759
Position Id: 30282-17456-1792075077
Posted 3 hours ago

Fitment