Thryve Digital Health - Business Analyst - Claims Adjudication

Role Summary:

- This job provides expertise for standard to moderately complex problem solving and in-depth understanding of system functionality.

- The incumbent reviews significant amounts of information and analyzes processes to support business unit needs.

- May troubleshoot errors, conduct impact analyses, and/or solve data rejection.

- Performs business analyses in one or more operational areas.

- Identifies process gaps and recommends process improvements for efficiencies.

- May provide guidance to Associate level employees.

Job Role : Business Analyst - Claims Adjudication with FEP

Experience - 6-9 Years

Work Location - Chennai/Hyderabad

Work Mode - Hybrid

Shift - 3PM - 12AM

Essential Responsibilities

Analyze Claims Tickets :

- Research/analyzes provider/Claims issue at hand

- Determines if provider/claim specific or global issue

- Actions taken could be ticket submissions to HMHS, pricing updates, provider file updates, collaboration with various internal stakeholders or Provider Relations, communications sent to Operations on global issues

- Request's cleanup report once issue is corrected, if required

- Follows cleanup through completion and notifies Provider Relations

- Facilitate process improvement meetings and/or discussions.

- Analyze the functions and operations of a business area/function and identify problem areas.

- Create process mapping and document current and future state business processes.

- Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies

- Assist in the development of desktop procedures and/or training material.

- Coordinate, monitor, and report on the progress of clean-up projects to ensure adherence to defined project schedule

- Communicate effectively with customers and colleagues.

- Successfully articulate issues, problems, and solutions.

The experience we are looking to add to our team require:

- 6-9 years' experience in Claims and Adjustments in Federal Employee Program (FEP) business

- Business Analyst with minimum 2 years of experience in FEP.

- Claims and Adjustment subject matter expertise

- Can adjudicate and adjust the claims

- BlueCard Home and Host knowledge

- Strong claims research skills are a must

- High level of systems and business knowledge

- Knowledge of INSINQ, Oscar, OCWA, CPBRE (Oscar Benefits), FEP Direct

Business Process Improvement:

- Collaborative Problem Solving

- Excellent analytical and problem-solving skills

- Bachelor's or master's degree in any discipline

- Good verbal and written skills

- Good analytical and interpersonal skills

- Exceptional people management

Good to have:

- AHM or any equivalent certification

- Additional quality/operational certifications

- Business acumen on Adjustments and Offset/Recovery