Advisor - Claims Ba

1 month ago

Chennai, India Thryve Digital Full time

Claims Business Analyst
- Thryve Digital Health LLP is an emerging global healthcare partner that delivers strategic innovation, expertise, and flexibility to its healthcare partners. Being a US healthcare conglomerate captive, we have direct access to deeper insights that help us accelerate our learning process and keeps us ahead of the curve. Thryve delivers next-generation solutions that enable our healthcare partners to provide positive experiences to their consumers.- Role Summary:
- Essential Responsibilities- Utilizes and participates in the more complex full system development life cycle, per current Highmark SDLC standards.
- Takes a lead role in collaborating with customers, partners, and IT team members to understand business requirements that drive the analysis and design of quality technical solutions. Concentrates on providing innovative solutions to more complex business needs.
- Takes a lead role in providing required business analysis support, including release implementations, on-call and 24x7 supports when necessary.
- Performs work in compliance with all Highmark and Highmark IT standards, policies and procedures.
- Effectively communicates with team members, customers, partners and management, including assisting with or conducting more complex technical walkthroughs, reporting project status, enabling vendor solutions and providing accurate and concise documentation.
- Other duties as assigned or requested.

Required- Bachelor’s or Master’s degree in Information Technology or related field or 6 years of related and progressive experience in lieu
- Work experience in EHR/EMR is also considered, but must have worked or possess knowledge of claims submission to Payers
- Should have knowledge in working with all types of claim - medical, hospital, Pharmacy, Dental, Vision, Blue card/ITS etc
- Should have sound knowledge in claims testing end to end, work under mínimal supervision and take complete ownership of delivery
- Sound have knowledge of current US federal and state laws with regards to healthcare governance and policies, and preferable to have PAHM/FAHM certifications or working towards certification
- Preferable to have basic SQL knowledge
- Business Analysis knowledge is mandatory, and preferable to have certifications like CBA/CBAP or working towards certification
- Should have experience in writing functional specification documents/BRD
- Should have the fundamentals of requirement gathering, elicitation, documenting, and transition over to internal and external stakeholders
- Should have ability to solve the complex business problems and exposed to complete software development life cycle (SDLC)
- Enthusiastic to learn and willing to work in flexible timing, and may require to work on weekend as per business need

Good to have- Experience in delivery management for US Healthcare Payer customers
- Agile delivery methodology - Nice to have work exposure with agile and scrum teams
- Membership and provider domain knowledge/experience is preferable

**Short Info**:

- Posted: 0 day(s) ago- Qualifications: Any engg degree- Experience: 12 Years To 15 Years

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