business analyst iii (claims)
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Job Summary
The Business Analyst III acts as the primary liaison between IT and the operational departments within the
organization. This position functions in a trusted advisor role. It provides subject matter expertise to the clients
in which it serves through analysis and the development of business and functional requirements for initiatives
of all sizes. The Business Analyst III serves in a relationship management role to increase customer service,
and participates on project teams to assist in timely delivery of IT project initiatives. This role also serves as a
mentor to team members.
This position will primarily support the Claims Dept functional area of the organization.
Responsibilities
Serves as technical and subject matter expert for initiatives involving claims processing.
Leads and guides workgroups through the evaluation of current state processes. Performs analysis to
define opportunities to create improved future state workflows/solutions (end-to-end process flow
development)
Assists management and end users in evaluating vendor software applications.
Leads and facilitates requirements and design sessions. Documents business and functional specifications
used for software design and development including software traceability matrices and use case diagrams.
Conducts requirements reviews to obtain sign-off from project/operational stakeholders.
Sets projects timelines with identified deliverables. Creates task lists/project plans for smaller initiatives.
On larger project initiatives completes assignments as defined by the Project Team.
Reports project status updates to stakeholders
Identifies issues and facilitates problem resolution for manual, batch and online environments. Ability to
interrogate error codes
Uses metrics and data to lead process improvement initiatives
Analyzes and queries data; has knowledge of the Facets data models
Data mapping, including the creation of file specifications; source to target mapping
Testing, including the creation of test scenarios, test data and understanding of outcomes
Mentors customers and peers
Communicates internally and externally with all levels of employees including senior management
Interacts with all areas of Information Technology as well as software vendors
End-to-end ownership of assigned initiatives – requirements through implementation
Keeps current with industry trends and state/federal compliance initiatives
Participates in user groups
Qualifications
BA/BS - Bachelors Degree or equivalent required. Degree in Computer Science or Computer
Programming a plus
Minimum 5-8 years previous experience as a Business/Systems Analyst
Health Care Industry experience
Previous experience and business knowledge with health care claims adjudication systems, including the
end-to-end life cycle of a claim and standard outputs (EOBs, RAs), EDI 837 and 835 transactions.
Knowledge of health care benefits and product offerings including NY State of Health exchange plans,
Medicaid, Medicare, Dual, Child Health Plus and Managed Long Term Care programs
Previous experience with TriZetto Facets applications preferred.
Proficiency with SQL (querying, analyzing and mapping data)
Demonstrated ability to ..
o Lead and elicit business needs and requirements from a diverse set of stakeholders
o Document and communicate requirements to the stakeholders, developers and testers.
o Construct or modify use case diagrams and process models.
o Create and execute test scenarios
Experienced in full software development life cycle
Understanding of the concept of online and batch environments
Excellent PC skills utilizing Microsoft Office software (Excel, Word, Visio, PowerPoint, and Access)
Proven problem solving and analytical skills
Detail oriented with the ability to manage multiple tasks simultaneously
Excellent organization and follow through skills
Excellent interpersonal, written and verbal communication skills
Ability to build and maintain good rapport with internal and external customers and handle situations with
confidence, tact and resourcefulness
Flexible, adaptable with the ability to work under pressure to meet deadlines in a fast paced environment
Strong team player