Business Analyst - Claims
- Thryve Digital
- 6 - 9 years
- Chennai
- 7 months ago
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Job Description
Role Summary:
This job provides expertise for standard to moderately complex problem solving and in-depth understanding of system functionality. The incumbent reviews significant amounts of information and analyzes processes to support business unit needs. May troubleshoot errors, conduct impact analyses, and/or solve data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. May provide guidance to Associate level employees.
Essential Responsibilities
Analyze Claims Tickets -
Research/analyzes provider/Claims issue at hand
Determines if provider/claim specific or global issue
Actions taken could be ticket submissions to HMHS, pricing updates, provider file updates, collaboration with various internal stakeholders or Provider Relations, communications sent to Operations on global issues
Requests cleanup report once issue is corrected, if required
Follows cleanup through completion and notifies Provider Relations
Facilitate process improvement meetings and/or discussions.
Analyze the functions and operations of a business area/function and identify problem areas. Create process mapping and document current and future state business processes.
Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies
Assist in the development of desktop procedures and/or training material.
Coordinate, monitor, and report on the progress of clean-up projects to ensure adherence to defined project schedule
Communicate effectively with customers and colleagues. Successfully articulate issues, problems, and solutions.
The experience we are looking to add to our team require:
6-8 years experience in Claims and Adjustments in Federal Employee Program (FEP) business
Skills:
Business Analysis skills
Claims and Adjustment subject matter expertise
Can adjudicate and adjust the claims
Bluecard Home and Host knowledge
Strong claims research skills are a must
High level of systems and business knowledge
Knowledge of INSINQ, Oscar, OCWA, CPBRE (Oscar Benefits), FEP Direct
Business Process Improvement
Collaborative Problem Solving
Excellent analytical and problem-solving skills
Bachelors or masters degree in any discipline
Good verbal and written skills
Good analytical and interpersonal skills
Exceptional people management
Good to have:
AHM or any equivalent certification
Additional quality/operational certifications
Business acumen on Adjustments and Offset/Recovery
Job Classification
Industry: IT Services & ConsultingFunctional Area / Department: Data Science & AnalyticsRole Category: Business Intelligence & AnalyticsRole: Business AnalystEmployement Type: Full timeContact Details:
Company: Thryve DigitalLocation(s): Chennai
Keyskills: Business Analysis process mapping Claims management desktop procedures Federal Employee Program OCWA INSINQ CPBRE FBOA Oscar
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