Business Analyst with Claims

Sr. Business Analyst With Claims

Responsibilities:

• Develop strategies to meet first pass resolution benchmarks and improve claims processing accuracy.
• Analyze claims data to identify trends and bottlenecks, providing actionable insights for process improvements.
• Lead elicitation and documentation of business requirements for claims transformation projects and system enhancements and for Facets configurations for accurate claims adjudication.
• Collaborate with compliance teams to audit processes and develop risk mitigation strategies.
• Lead Agile ceremonies and use Azure DevOps (ADO) to manage backlogs, sprints, and work item tracking.
• Gather information to prioritize user stories related to claims enhancements and system configurations with steering committee and teams.
• Act as the primary liaison between business units, IT teams, and leadership to align goals and initiatives.

Qualifications:

• 7+ years of prior experience as a Business Analyst or other IT role, such as support or development.
• BA / BS in IT, statistics, computer science, mathematics, information management, or a related field or equivalent experience.
• Strong investigative, analytical skills.
• Skilled at defining and documenting business and functional requirements for ongoing system enhancement initiatives in agile software development environments.
• Experience writing clear acceptance criteria to a testable level.
• Experience with EDI file formats and other proprietary data exchange formats.
• Experience leading or participating in all Agile meetings including sprint planning, sprint grooming, review, demo, stand-up, and retrospective sessions.
• Microsoft Office experience: Word for documentation, Excel for data handling, excellent skills with Visio for diagrams, PowerPoint for presentation and Outlook for email.
• Firm understanding of relational databases, database structures and design, and data management.
• Solid SQL knowledge, experience writing investigative queries, firm understanding of joins.
• 3+ years of experience in healthcare and or with claims adjustment software.
• Experience with Facets is a plus.

Preferred Qualifications:

• Ability to become a Subject Matter Expert on various healthcare, insurance, pension, and/or payroll technology systems.
• Experience working on different project types, such as off-the-shelf, new development, enhancements projects.
• Experience with Azure DevOps
• General knowledge of databases, applications, system interfaces, and operating systems.
• Knowledgeable in SDLC, Agile and/or Waterfall methodologies.