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Detailed Job Description:

Skill Set: Work closely with internal and external stakeholders to elicit business requirements Analyze business requirements and develops functional design specifications that include business rules, data mapping tables, logical flow charts, edit logic, etc. Usage of industry tools for requirement gathering, business processing modelling, defect/ CR/ Document Control tools Mandatory Skills Working knowledge of Claims processing, membership in US healthcare. Exposure to writing, understanding SQL Queries. Planning and Co-ordination skills. Exposure to Agile Methodologies and to tools like JIRA. Facilitate Scrum events such as backlog creation/grooming, prioritization, stand up meetings, estimation, showcase and retrospectives. Participate and/or Lead scrum adoption practices across the organization. Facilitate the documentation of working agreement, definition of ready and definition of done for the scrum team. Work with the scrum teams to improve metrics as necessary. Expertise in Claims Processing in HMO/PPO/POS and Medicaid/Medicare. Strong understanding of FACETS and Facets Data Modelling. Working experience of 5+ years in health insurance industry Good understanding of health insurance macro business functions and processes. Working knowledge of writing user stories, EPICS, Features. Experience with Informatica-Power Center.

Minimum years of experience*: 5-8 years

Certifications Needed: No

Top responsibilities you would expect the Subcon to shoulder and execute*:

Healthcare BA role with Payor experience. Working knowledge of healthcare data Working knowledge of writing user stories, EPICS, Features