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IT Business Analyst (API Integration, Healthcare System)

Salary undisclosed

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SEVEN SEVEN GLOBAL SERVICES IS LOOKING FOR AN IT BUSINESS ANALYST!

Work Setup: WFH

Work Schedule: Dayshift

Roles and responsibilities:

  • Analyze and document the business & operational needs for the health claims software solution, ensuring alignment with industry standards, regulatory guidelines, and client needs.
  • Collaborate with stakeholders, including clients, software developers, product managers and implementation managers, to define the scope, objectives, and deliverables of the product delivery to the customer.
  • Conduct detailed analysis of existing processes and workflows related to health claims processing, clinical coding, and benefits administration based on clients as-is process and propose to-be process based on the products offering.
  • Identify gaps in operations & industry practices and recommend solutions to optimize operational efficiency and accuracy with compliance to regulatory requirements.
  • Develop and maintain comprehensive documentation, including user-needs, functionalities, user stories, and acceptance criteria scenarios.
  • Collaborate with the product manager and implementation lead to ensure that the product solution meets the defined requirements to deliver value to customers and solve their pain-points.
  • Conduct thorough analysis of business processes such as benefit definition, claim matching, etc. that involve clinical coding and workflows to build required capabilities from inception.
  • Thorough understanding of the product offering and ability to localize it to new markets through defining localization features.
  • Ability to breakdown features into epics, stories, and task for development and groom the stories to meet the definition of ready as per agile best practices.
  • Collaboration with business and systems architects on overall product implementation feasibility and standards.
  • Conduct user acceptance testing to validate the functionality, usability, and performance of the software solution to meet the definition of done as per agile best practices and customer needs.
  • Stay up-to-date with industry trends, regulatory changes, and emerging technologies relevant to health claims processing and clinical coding
  • Post go-live operationalization support to client to facilitate migration, initial setup & provide training.

Knowledge and Experience:

  • Minimum 5 years of experience with proven expertise in business and product analysis in health insurance industry.
  • Familiar with Test-Driven-Development (TDD) approach and Agile best practices.
  • Subject matter expertise of claims processing and related areas such as clinical coding, health benefit codifications, alternative reimbursement models for provider pricing, etc.
  • Familiar with claims and benefit data structure and related industry standard, HL7 FHIR data standard is preferred.
  • Previous SaaS experience is preferable.