Business Analyst with health insurance/Health plan
Minimum Requirements:
· Bachelor’s degree or equivalent
· 3 - 5 years of experience in the field of Health Plan business analysis, software validation and testing for client/server, multi-tier and Web-based applications for health insurance companies’ Medicare and commercial business lines (Health Plan experience is required)
· Extensive involvement in the planning, design and testing phases of SDLC, with specific expertise in requirements analysis and business specification, development, enhancement, quality assurance, testing methodologies and implementations
· Thorough knowledge of business analysis and the iterative software development life cycle using rapid application development (RAD)
· Proficiency in customizing and implementing RAD in planning, design and testing phases during software development
· Proficiency in creating data flow diagrams and data models including use case diagrams, activity diagrams/ state chart diagrams, collaboration diagrams, deployment diagrams, entity-relationship diagrams and Web-page mock-ups using Microsoft FrontPage and Visio
· Experience with member eligibility and enrollments along with 834, 837 and 835 files
· Experience with a wide range of provider contract types, for example, capitation contracts (according to sex and range of a plan member), HCFA-1500, inpatient and outpatient based on remuneration per admission, inpatient and outpatient per line item, case-based contracts, out-patient service contracts, contracts based on global fee and capitation reimbursement methods
· Familiarity with member coverage based on benefit plans, dependent eligibility and pre-existing conditions rules
· Experience with claims adjudication and procedures, including pay professionals and members, select individual claims for payments, change the claims status of an individual payment to hold or release, and create, print or display explanation of benefits (EOB) for a member or explanation of payments (EOP) for a provider
· Experience working with the reports and letters along with ID card management
· Willingness to work overtime, as necessary
Description:
· Collect, understand and transmit business requirements for projects (multiple technology modules and systems), and translate these into functional specifications, database designs and detailed test plans
· Partner with customers to gather all requirements to formulate business process specifications and translate those into application functionality, understanding the value proposition(s) of the project and deciding when to advocate and when to compromise to arrive at mutually acceptable solutions
· Document workflows and the results of business analyses, and obtain sign-off from clients on specifications
· Assist the technical team in translating application functionality into application architecture and the production of system functionality documents
· Communicate business directives, goals and needs to the technical team and serve as a client interface for managing user expectations and client satisfaction
· Design and execute test plans, tracking defects and getting them resolved to ensure that business requirements and functional specifications are tested and fulfilled
· Support the development of software and user help documents for multiple health insurance product lines
Participate in and/or execute the multiple stages of testing (i.e., system, integration, installation, performance, regression)