Sr. Analyst, Claim Processing Business Analysis

Conduent - Stockbridge, GA2.8

Full-timeEstimated: $75,000 - $110,000 a year
Skills
Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.

We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.

Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com .

Title: Sr. Analyst, Claim Processing Business Analysis

Purpose:
Responsible for analyzing customer Claim Adjudication requirements and the analysis of information/data. Manages projects if required. Provides input to improve overall efficiency and processes.
The role holder) is responsible for leading the effort to understand the business needs and identify how best to meet those needs. This includes working with the business and the technology areas to gather requirements for development and management. The role leads the effort to analyze, validate and document the business and system requirements.
The role holder is a key facilitator within the IT organization, acting as a bridge between the business and the IT groups, and is accountable for a technology solution that supports the business request or opportunity and is based on the enterprise architecture. This role partners with the Architect during the initial stages of the project/solution to ensure the accuracy of business cases and that the solution will meet the business need.
This role designs, modifies and creates business processes that will be used to implement the business transformation solutions. This is done through research and fact-finding combined with a basic understanding of applicable business processes, systems, and industry requirements.
The role holder determines the process and requirements management methodology practices. The role monitors the effort to ensure that the methodology and quality standards are being met.

Scope:Specific:
Multiple business processes, or sub-processes, spanning one or more geographic regions and/or business units.

Autonomy:
Has defined authority and responsibility for a significant area of work, including technical, financial and quality aspects.
Establishes organizational objectives and delegates assignments.
Accountable for actions and decisions taken by self and subordinates.

Influence:
Influences policy formation on contribution of specialization to business objectives.
Influences at level of division internally and influences customer/suppliers and industry at senior management level.
Decisions impact work of employing organizations, achievement of organizational objectives and financial performance.
Develops high-level relationships with customers suppliers and industry leaders.

Complexity:
Can absorb complex technical information and communicate effectively at all levels to both technical and non-technical audiences.
Is able to assess and evaluate risk and to understand the implications of new technologies.
Demonstrates clear leadership skills and the ability to influence and persuade.
Has a broad understanding of all aspects of information systems and deep understanding of area(s) of specialization.
Understands and communicates the role and impact of information systems in the employing organization.
Takes initiative to keep both own and subordinates skills up to date and to maintain awareness of developments in the information systems industry.

General:
Recognized as an expert in own function
Interprets internal or external business issues and recommends solutions/best practices
Decisions are guided by resource availability and functional objectives
Primarily domestic scope/accountability; may include some international scope/accountability
Progression to this level is typically restricted on the basis of business requirement

Primary Responsibilities:
Knowledge of Claims Adjudication Processing, Benefit Plan and NCCI processing, X12 mapping and knowledge of HIPAA companion guides.
Minimum of 7 years of experience as a Business Analyst on a Medicaid Management Information System (MMIS).
MMIS experience on at least one development project and possible maintenance experience (post project implementation).
Oracle SQL skills or comparable.
Must be currently eligible to work in the US for any employer without sponsorship.
Exceptional skill in writing formal documents in English
Experience writing BRDs, user stories, user scenarios, use cases, detailed functional specifications, etc. in natural language according to organizational standards.

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form .
Job
IM Business Analysis
Primary Location
United States-Georgia-Stockbridge
Organization
ITS
Unposting Date
Ongoing
Travel
Yes, 25 % of the Time