Senior Business Analyst – Claims module
Jobs via Dice · United States
- Hybrid
- Full-time
- $120,000 / year
- United States
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Job highlights
- Lead claims module for MMIS health care projects.
- Analyze requirements, design documentation, ensure quality.
- Requires strong Medicaid and Medicare domain knowledge.
- Hands-on claims processing and adjudication experience needed.
- Collaborate with clients and development teams.
About the role
Senior Business Analyst – Claims module
Dice is the leading career destination for tech experts at every stage of their careers. Our client, Carman Solutions Group, is seeking the following. Apply via Dice today!
Job Summary
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 a team environment and provides guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application, and assist customers in implementation decisions.
Required Qualifications
- Strong health care domain experience with good knowledge of Medicaid and Medicare.
- Hands-on experience in claims processing and Adjudication processes.
- Good experience in Reference code/data sets required in Claims adjudication.
- Prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
- Ability to run queries and perform basic system analysis, RCA, etc.
- Must work closely with the client and development team during development stages, conduct demos, and track feedback.
- Excellent written and spoken communication skills.
- Ability to multitask between internal teams and clients.
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 data flow between systems and formats, using tools like Postman.
Preferred Skills
- Minimum of 8+ years of experience in health care, especially in the MMIS domain.
- Capability to think out-of-the-box to create new solutions.
- Ability to validate test scenarios and test plans, test data.
- Review requirements, documentation, and create Requirements Traceability Matrix (RTM).
- Excellent communication skills to engage with stakeholders like QA/dev teams, clients, and end-users.
- Ability to assess current product functionality against market trends and regulatory requirements.
- Ability to drive and share requirements with Technical and Architects regarding product features.
Key Skills/Competency
- Senior Business Analyst
- Claims Module
- MMIS
- Health Care Domain
- Medicaid
- Medicare
- Claims Processing
- Adjudication
- SQL
- EDI
Skills & topics
- Senior Business Analyst
- Business Analysis
- Claims Processing
- MMIS
- Medicaid
- Medicare
- Health Care
- SQL
- EDI
- Remote
How to get hired
- Tailor your resume: Highlight your healthcare domain experience, MMIS, Medicaid/Medicare knowledge, and claims processing expertise.
- Showcase technical skills: Emphasize your proficiency in SQL, EDI tools, and interface testing relevant to claims adjudication.
- Demonstrate leadership: Provide examples of leading projects, guiding teams, and managing the full project lifecycle.
- Quantify achievements: Use numbers to show impact in areas like process improvement, customer satisfaction, or issue resolution.
- Prepare for technical questions: Be ready to discuss claims adjudication, reference data, and system analysis.
Technical preparation
Master SQL for backend data validation.,Practice validating X12 files with EDI tools.,Understand system data flow for interface testing.,Prepare to analyze and troubleshoot claims issues.
Behavioral questions
Describe a complex claims issue you resolved.,How do you manage conflicting stakeholder priorities?,Provide an example of driving process improvement.,How do you ensure quality in documentation?
Frequently asked questions
- What specific healthcare systems experience is most valuable for this Senior Business Analyst role at Carman Solutions Group?
- For this Senior Business Analyst position focusing on the Claims module, strong experience with MMIS (Modular Medicaid Information System) is highly preferred. Additionally, deep knowledge of Medicaid and Medicare claims processing and adjudication is crucial. Familiarity with configuring benefits and understanding reference data sets within these systems is also key.
- How important is SQL and EDI knowledge for the Senior Business Analyst role?
- SQL and EDI knowledge are very important for this Senior Business Analyst role. You'll need SQL to validate data in backend tables, like claim status and payment details. Familiarity with EDI tools is necessary for validating X12 files, which are common in claims processing.
- What does it mean to 'Play the role of Claims Domain lead' in this position?
- As the Claims Domain Lead, you will be the primary expert for the claims module within MMIS healthcare projects. This involves guiding the team, driving the claims process and domain knowledge, performing detailed analysis of business requirements, and ensuring the quality of the claims-related processes throughout the project lifecycle.
- Is this Senior Business Analyst position fully remote, and what are the expectations for client interaction?
- Yes, this position is fully remote. Despite being remote, you will be expected to work closely with the client and the development team. This includes conducting demos at the completion of milestones and gathering/closing feedback from these sessions. Excellent communication skills are essential for effective remote collaboration.
- What kind of documentation is expected from the Senior Business Analyst?
- The Senior Business Analyst is expected to perform analysis of business requirements and design/develop relevant documentation. This could include functional specifications, process flows, and potentially a Requirements Traceability Matrix (RTM), as mentioned in the preferred skills.