Technical Business Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Possess a strong understanding of the healthcare payer sector with at least 10 years of relevant experience.

• Have prior experience in the implementation and maintenance of commercial payer claims solutions and/or Medicare/Medicaid systems.

• Demonstrate solid experience with claims processing concepts, alongside provider, member enrollment, and care management principles.

• Have substantial familiarity with reference codes/data sets essential for claims adjudication, including but not limited to CPT, CDT, HCPCS, and ICDs.

• Bring prior experience or knowledge in configuring benefits or programs within claims systems across diverse sub-systems.

• Collaborate with clients to create and gather requirements, documenting them in accordance with established standards.

• Comply with (or, if necessary, establish) processes for requirement solicitation, documentation, and handoff.

• Collaborate closely with the IT development team to clarify requirements and facilitate constructive discussions/brainstorming sessions to implement top-tier solutions.

• Have a basic understanding of concepts such as web services and relational databases.

• Capable of executing queries and performing basic system analyses, including root cause analysis (RCA).

• Able to create mapping documents for various interfaces that incorporate business rules, transformations, and database mappings.

• Work in close partnership with the client and development team throughout the development phases, conducting demonstrations upon milestone completion and managing feedback from such sessions.

• Exhibit excellent written and verbal communication skills, with the ability to manage multiple tasks between the internal team and clients based on priority.

• Collaborate closely with development, architecture, and design teams to establish the GUI view and platform requirements, which underpin the product.

⛳️ Requirements

• Strong understanding of the healthcare payer space with a minimum of 10 years of experience in the domain.

• Prior experience in the implementation and maintenance of commercial payer claims solutions and/or Medicare/Medicaid systems.

• Solid experience with claims processing concepts, including provider, member enrollment, and care management methodologies.

• Familiarity with reference codes/data sets integral to claims adjudication, including but not limited to CPT, CDT, HCPCS, and ICDs.

• Previous experience or understanding in configuring benefits or programs in claims systems across various sub-systems.

• Ability to collaborate with clients to create and gather requirements and document them according to established standards.

• Adherence to (or, if necessary, establishment of) processes for requirement solicitation, documentation, and handoff.

• Close collaboration with the IT development team to clarify requirements and foster constructive discussions/brainstorming sessions for optimal solutions.

• Basic understanding of concepts like web services and relational databases.

• Capability to run queries and conduct basic system analysis, including root cause analysis (RCA).

• Ability to create mapping documents for various interfaces, including business rules, transformations, and database mappings.

• Close collaboration with clients and development teams during development stages, conducting demonstrations at milestone completion and managing feedback from those sessions.

• Exceptional written and spoken communication skills, with the ability to multitask between internal teams and clients based on priority tasks.

• Collaboration with development, architecture, and design teams to define GUI view and platform requirements, forming the foundation of the product.

• Ability to think creatively to develop new solutions as required.

• Previous experience as an IT QA or Developer within a healthcare system is advantageous but not mandatory.

• Competence in validating test scenarios, test plans, and test data.

• Ability to review requirements, documentation, and create a Requirements Traceability Matrix (RTM).

• Excellent communication skills (both written and verbal) to engage with various stakeholders, including QA/dev teams, clients, end users, and business units.

• Ability to assess current product functionalities in relation to market trends and regulatory requirements to be incorporated into future versions of the product.

• Capability to convey and share requirements with technical teams and architects regarding product features to be implemented.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and career advancement.

• Flexible work schedule and remote work options.

• Supportive team environment and company culture.