Description

Analyzes US healthcare workflows for payers, TPAs, and insurance domains, managing requirements for claims, billing, and enrollment. This role is on-site.

Responsibilities

• Analyze healthcare workflows including claims, clinical edits, pricing, and benefit plans.
• Manage requirements for premium billing, enrollment, payments, and reinsurance/stoploss.
• Execute Agile processes such as writing user stories, grooming, sprint planning, and backlog refinement.
• Facilitate technical documentation and process mapping using Visio and JIRA.

Required Skills

• 8+ years of related work experience.
• 5-8 years of experience within the US Healthcare industry.
• Deep knowledge of EDI transactions (834, 835, 837, 278, 270/271, 276/277).
• Working knowledge of HIPAA regulations.
• Proficiency in Microsoft Excel, Word, PowerPoint, and Visio.
• Experience using JIRA within an Agile environment.
• Advanced mathematics aptitude and analytical comprehension.

Preferred Skills

• Project Management experience.

Key Skills

Education

Any Gradute