Role: Senior Business Analyst with Claims module
Location: Remote
Primary skills: Strong experience/ knowledge of Claims Process- How claims are processed and how pricing is done in Medicaid Field.
Senior Business Analyst – Claims module:
Play the role of Claims Domain lead for MMIS health care projects. Drive the claims module and process, domain knowledge, perform analysis of business requirements, design and develop documentation, ensure quality process, coordinates with customers. Works in team environment and provides guidance throughout the entire life cycle. Responsible for meeting customer expectations, troubleshooting problems in the application and assisting customers in implementation decisions.
1. Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
2. Candidate should have hands-on experience in claims processing and Adjudication processes.
3. Must have good experience in Reference code/data sets required in Claims adjudication.
4. Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.
5. Should be able to run queries and perform basic system analysis, RCA etc.,
6. Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
7. Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
8. Work Closely with Dev, architecture, and Design teams to define the GUI view and platform requirements, which is the foundation of the product.
9. In depth understanding of Claims and Claims lifecycle:
- Member
- Provider
- Claim submission – Paper and EDI X12
- Adjudication
- Payment Cycle (Finance)
- Reporting
10. Claim Types:
- Professional
- Dental
- Institutional
- Pharmacy
- Encounters and Capitation
11. Claim Formats:
- EDI X12 formats like 837P/I/D
- X12 formats 835, 834, 270/271, 276/277
12. Claim System:
- Familiarity with systems like CMdS, GHS, Facets and etc
Skills Required
- Strong healthcare domain experience with knowledge of Medicaid and Medicare
- Hands-on experience with claims processing and adjudication
- Experience with reference codes and data sets used in claims adjudication
- Experience or understanding of configuring benefits or programs across claims-system subsystems
- Ability to run queries, perform basic system analysis, and conduct root-cause analysis
- Experience collaborating with clients and development teams through development milestones
- Excellent written and spoken communication skills
- Ability to multitask across internal team and client priorities
- Understanding of the complete claims lifecycle, including members, providers, submission, adjudication, payment, and reporting
- Knowledge of professional, dental, institutional, pharmacy, encounter, and capitation claim types
- Knowledge of EDI X12 formats 837P, 837I, 837D, 835, 834, 270/271, and 276/277
- Familiarity with CMdS, GHS, Facets, or similar claims systems
- Ability to work with development, architecture, and design teams on GUI and platform requirements
Hexaware Technologies Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Hexaware Technologies and has not been reviewed or approved by Hexaware Technologies.
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Healthcare Strength — Feedback suggests health insurance is a standout element, often described as strong and comparable or better than many employers. Medical coverage and related protections are repeatedly highlighted as reliable pillars of the package.
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Parental & Family Support — Parental leave options, including extended paid leave in some locations, are offered and seen as valuable for family needs. Feedback suggests these policies complement core medical coverage for a more complete family safety net.
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Wellbeing & Lifestyle Benefits — Wellbeing resources such as an Employee Assistance Program, wellness initiatives, on-site gyms, and engagement activities provide lifestyle support. These offerings are reinforced by flexible work options and shift-related extras where applicable.
Hexaware Technologies Insights
What We Do
At Hexaware, we're not just a global technology and business process services company; we're a community of 27,000 Hexawarians dedicated to one singular purpose: creating smiles through the power of great people and technology. With a presence in 40+ offices across 19 countries, we empower enterprises worldwide to embark on their digital transformation journey with unparalleled scale and speed. As an employer, we're more than just a workplace. We put our people first, foster diversity and inclusivity, and prioritize their growth through robust learning and development programs. Our culture is a canvas for innovation as we work toward our shared vision of becoming the world’s most loved digital transformation partner. Exciting, isn’t it? Visit www.hexaware.com to join us in embracing the magic of technology, as we passionately advocate for its potential to transform lives today and shape a brighter future. Together, we'll make the digital world a better place.
