Senior Claims Business Analyst
About The Position
Review project artifacts/deliverables throughout the system development life cycle for quality, compliance, and completeness, document observations and findings using project team processes and standards. Analyze and document business, technical, and user requirements related to Medicaid Claims Adjudication and other functional areas. Collaborate with state business users, vendors, and internal teams to ensure alignment on project goals and deliverables. Identify and communicate project risks, issues, and dependencies. Conduct research and provide recommendations to resolve business challenges. Develop and execute User Acceptance Testing (UAT) Create and deliver presentations and training materials for business users and stakeholders.
Requirements
- Minimum 10 years of experience in supporting or developing Health Care systems
- Minimum 9 years of experience in supporting large, complex Medicaid implementation projects, system development methodology and project management principles
- Minimum of 9 years of experience in Medicaid Claims Adjudication, including understanding of claims processing workflows, adjudication rules, mass-adjustments, and system functionality
- Minimum 9 years of experience with elicitation and verification of business and technical requirements
- Minimum 9 years of experience conducting reviews of system development life cycle documentation, project and technical architecture, and design deliverables/artifacts
- Undergraduate degree or 4 additional years of relevant experience
- Experience translating Federal and State regulations into working requirements that are actionable by technical teams
- Experience working with Medicaid Enterprise Systems (MES) vendors
- Experience with claims editing tools, adjudication engines, or Medicaid analytics platforms
- Ability to bridge communication between non-technical business users and technical teams
Responsibilities
- Review project artifacts/deliverables throughout the system development life cycle for quality, compliance, and completeness, document observations and findings using project team processes and standards.
- Analyze and document business, technical, and user requirements related to Medicaid Claims Adjudication and other functional areas.
- Collaborate with state business users, vendors, and internal teams to ensure alignment on project goals and deliverables.
- Identify and communicate project risks, issues, and dependencies.
- Conduct research and provide recommendations to resolve business challenges.
- Develop and execute User Acceptance Testing (UAT)
- Create and deliver presentations and training materials for business users and stakeholders.
Benefits
- This position may also be eligible for incentive compensation based on individual and/or company performance.
- This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and AD&D insurance, short and long term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally-required benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
