Advisor - Claims Ba

2 weeks 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

  • Ba Claims

    2 weeks ago

    Chennai, Tamil Nadu, India Virtusa Full time

    Role Summary Essential Responsibilities Utilizes and participates in the more complex full system development life cycle, per current Thryve 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...

  • Managing Business Advisor

    2 weeks ago

    Chennai, Tamil Nadu, India Capgemini Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Job DescriptionBusiness Advisors shape the vision and strategy with the client, understand the needs of the users/stakeholders, carry out an elicitation of processes, data and capabilities and derive the target processes and the business requirements for the current and future solution.Job Description - Grade SpecificDefine, plan and manage the business...

  • Service Advisor-Car Service

    2 weeks ago

    Chennai, Tamil Nadu, India Ohyes Events Manpower Solutions Full time ₹ 8,00,000 - ₹ 12,00,000 per year

    Urgent Hiring : Car Bodyshop / Service AdvisorJob SummaryThe Car Bodyshop / Service Advisor is the key contact between customers, insurance companies, and the workshop team. The role involves assessing vehicle damage, preparing accurate estimates, coordinating repairs, and ensuring high levels of customer satisfaction throughout the repair process.Key...

  • Bodyshop Advisor

    6 days ago

    Chennai, Tamil Nadu, India True Talents Consulting Pvt Ltd Full time

    **Role**:Bodyshop Advisor **Experience**:1+ Years **Location**:Chennai, Sholinganallur **Salary**: 20k **Contact no**:8610006037 - Previous experience in a similar role within the automotive or accident repair industry. - Strong understanding of vehicle body repair processes. - Excellent communication and interpersonal skills. - Proficient in using...

  • Managing Business Advisor

    2 weeks ago

    Chennai (ex Madras), India Jobted IN C2 Full time

    Job Description Business Advisors shape the vision and strategy with the client, understand the needs of the users/stakeholders, carry out an elicitation of processes, data and capabilities and derive the target processes and the business requirements for the current and future solution. Job Description - Grade Specific Define, plan and manage the...

  • Insurance Advisor

    4 days ago

    Chennai, Tamil Nadu, India Mosahay associate pvt ltd Full time

    An insurance advisor in an agency channel role typically has the following responsibilities: - **Provide insurance advice**: Help clients find the best insurance policies for their needs - **Analyze policy details**: Process policy adjustments and renewals - **Help with claims**: Assist clients with insurance claims and ensure they are satisfied with their...

  • Life Insurance Advisor

    2 days ago

    Chennai, Tamil Nadu, India 8Queens Software Technologies Private Limited Full time ₹ 2,16,000 - ₹ 5,73,894 per year

    A Life Insurance Advisor helps individuals and businesses select appropriate life insurance policies based on their financial goals, needs, and risk tolerance.Their core responsibilities include assessing client needs, recommending tailored insurance plans, explaining complex policy details clearly, supporting clients through the purchase process, and...

  • Healthcare Business Analyst

    2 weeks ago

    Chennai, India Reveleer Full time

    Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of...

  • Life Insurance Advisor

    15 hours ago

    Chennai, Tamil Nadu, India 8QUEENS SOFTWARE TECHNOLOGIES PRIVATE LIMITED Full time

    A Life Insurance Advisor helps individuals and businesses select appropriate life insurance policies based on their financial goals, needs, and risk tolerance. Their core responsibilities include assessing client needs, recommending tailored insurance plans, explaining complex policy details clearly, supporting clients through the purchase process, and...

  • Bodyshop Advisor

    4 days ago

    Sholinganallur, Chennai, Tamil Nadu, India True Talents Consulting Private Limited Full time

    **Job Title**: Body Shop Service Advisor **Experience**: Minimum 2 Years **Location**:Sholinganallur, Chennai** **Industry**: Automotive / Service Center **Job Summary**: **Key Responsibilities**: - Welcome customers and understand their vehicle repair needs. - Prepare accurate job cards and damage estimates. - Coordinate with the body shop team for...