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Claims Business Analyst
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| Claims Systems Management |
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| Location: 55 Water Street, NY |
| Job Code:CBA CSM |
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| Essential Duties: |
The function of the Claims Business Analyst begins with the review of and revisions to the Business Requirements for proposed implementations in the Claims Department. The Claims Business Analyst is responsible for drafting and executing comprehensive test scenarios designed to validate that modifications to existing systems and procedures are yielding the anticipated result. The Claims Business Analyst must work with IS and other departments through the design, testing and execution of the implementation. The Claims Business Analyst also conducts post-implementation monitoring and provides continual follow-up support to the Claims Department and other Business Partners. The Claims Business Analyst is also responsible for documentation of test results, fixes, and correct functioning of all enhancements to existing systems and procedures.
- Testing of individual projects which includes development of test scenarios, recording and reporting of test results, and conducting post-implementation monitoring.
- Identify and communicate issues/problems to the Manager and testing team relating to testing and test outcomes that impact project deliverables. Complete all assigned tasks for each assigned test project on time and accurately.
- Responding to and resolving of production problems with implemented systems logic and organizational claims procedures.
- Participate in developing project plans for assigned testing projects based on review.
- Serve as the liaison with the Seniors and Managers in the Claims Operations concerning the business requirements, planning, testing and communication of projects.
- Providing subject matter expertise in the development and review of requirements, review and assistance with IS unit testing, and transition of projects and knowledge to other CSS Business Analysts.
Knowledge Skills & Abilities:
- Analytical, deductive reasoning and decision making skills sufficient to analyze the data and workflow, changing business requirements and the results of system testing.
- Have knowledge of automated systems and claims processing sufficient to prepare specifications and documentation for IS systems development staff.
- Able to communicate effectively and clearly, both orally and in writing.
- Have knowledge of operations and claims processing environments sufficient to present business requirements, review data, validate test results, develop procedures and recommend improvements.
- Exercise sound judgment.
- Able to be timely and efficient with attention to detail in a high volume environment.
- Able to absorb, retain and effectively apply a wide range of information about HIP policies, procedures and contractual benefits.
- Flexibility and patience to accommodate changes in testing plans and strategies.
- Ability to work under pressure and work long hours to meet project deadlines.
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| Qualifications: |
- Six (6) years of prior related work experience in professional and facility claims and HMO Benefits.Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement and EDP testing procedures.
- Require Associate’s Degree. A four year college degree is preferred. Additional related education, PC skills, training and/or experience is an asset.
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