Job Description

Role: Senior Business Analyst (Claims & Enrollment Systems)

Location: Remote

Project description

This position is responsible for understanding stakeholder needs and business issues to be addressed in the Enrollment Applications. Collaborate with the Product owner to assess configuration, EDI Eligibility transactions data mapping, Open Enrollment process, Exchange (Affordable Care Act) processes. Understand Eligibility and Premium billing functions. Assess requirements associated with new input and output Eligibility feeds, define UAT scope/testing needs and validate results. Act as point of contact for release notes, requirements and test cases related to Open enrollment processes and enhancements. Work alongside business and technical teams to increase collaboration and optimize productivity and communication. Ensure requirements and solutions conform to departmental, corporate, industry and government standards as specified.

Responsibilities

Solve Business Problems. Collaborate with business and technical stakeholders and vendors to understand the business problem that needs to be solved.

Create and modify existing data mapping between current and new system.

Plan, drive, and own the business analysis capability.

Own the delivery of the Business Requirements Package by performing stakeholder analysis, document business requirements using features and stories, develop process map and impact analysis and create traceability of business requirements to technical requirements, test cases and User Acceptance Test (UAT) cases.

Recommend Business Solutions. Evaluate and recommend business solutions to Business and IT leadership.

Collaborate with the operational team in resolving issues in production environment.

Coordinate UAT for assigned projects. Author UAT documentation deliverables (UAT Test Plan, UAT Test Results, and UAT Defect Log). Drive UAT execution and resolution of identified defects

Support Product Owner by tracking project progress, identifying risks, and communicating status to the business(es) and organizational leadership.

Document and maintain end-to-end process flows. Identify and implement opportunities to streamline upgrade and requirement processes.

Coordinate key requirement and UAT activities. Drive efforts and facilitate meetings. Partner with upstream and downstream stakeholders to ensure seamless and predictable outcomes.

Skills

Must have

a. Claims experience (Solid exp.)

b. ITS/Bluecard experience

c. HRP experience

Bachelor's degree in Computer Science, Business, Administration, Security, or related field or equivalent work experience.

Typically, 5-7 years of relevant experience.

Experience in Enrollment business (Group & Member) functions, Billing, Open Enrollment processes and ACA process.

Extensive knowledge in EDI Eligibility and Billing transactions.

Experience in input and output eligibility feeds reconciliation process and Data mapping

Skills required:

Business Analysis.

In-depth understanding in Enrollment functions and processing.

Experience in eligibility EDI transactions. Ability to reconcile input and output eligibility feeds.

Ability to perform queries via SQL.

MetaVance application knowledge

Strong communication skills.

Agile methodology and framework.

Working knowledge of MS Azure DevOps.

General understanding of related technologies.

Customer Service General Project Management.

Nice to have

Great communication skills

Job Tags

Hourly pay, Permanent employment, Full time, Contract work, Part time, Work experience placement, Internship,

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