Randstad USA Hiring For Healthcare Claims BSA at St Louis, MO Full Time

job summary:

Remote

9 / 6 CT. Yes, overtime may be required at times.

Please ensure that candidates can speak to what is on their resumes.

Summary: The main function of a business systems analyst is to analyze science, engineering, business and all other data processing problems for application to electronic data processing systems. A typical business systems analyst is responsible for analyzing user requirements, procedures and problems to automate or improve existing systems and review computer system capabilities, workflow and scheduling limitations.

Job Responsibilities: Supervise the testing, maintenance, and monitoring of computer programs and systems, including coordinating the installation of computer programs and systems. Advise clients regarding the nature of the information processing or computation needs. Advise management on current system principles and necessary updates and recommendations. Supervise the expansion or modification of system to serve new purposes or improve work flow. Interview or survey workers, observe job performance or perform the job to determine what information is processed and how it is processed. Train staff and users to work with computer systems and programs.

Skills: Verbal and written communication skills, problem solving skills, attention to detail and interpersonal skills. Expert ability to work independently and manage one’s time. Expert leadership and mentoring skills necessary to provide support and constructive performance feedback. Expert knowledge of design techniques and principles involved in production of drawings and models.

Education/Experience: Bachelor’s degree in a technical field such as computer science, computer engineering or related field required. MBA or other related advanced degree preferred. 10+ years experience required.

Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):

• Understand and review business requirements and requests from health plans related to claims processing in order to assess, understand and document system impacts associated with the request
• Hands-on investigation and triage of claims processing outcomes and working with claims data. Candidate must possess in-depth claims knowledge and experience with this type of claims triage to be considered an ideal candidate.
• Work closely with Product Owners and Scrum Masters to define/groom user stories, and prioritize the user stories for future Sprints – experience in an Agile environment is desired.
• Implement configuration related table changes based on health plan requests
• Coordinate releases across all team members and across interfacing systems
• Create process flows and documentation of existing and new system functionality
• Provide on-call support for IT processes
• Help identify process issues & define proactive resolutions for those issues through design changes,process flow changes,etc.
• Maintain/update business rules documentation for each health plan
• Identify dependencies and risks associated with system enhancements
• Investigate and triage issues associated with Claims processing using Advanced SQL/Oracle skills
• Perform detailed data mapping
• Experience working with APIs
• Ability to build stored procedures to access data from Oracle is desired
• Data science experience is a plus
• Experience running jobs through Control-M is desired

Describe the performance expectations/metrics for this individual and their team:

• Ensure claims are processed efficiently, meeting internal and government mandates rules, regulations, and SLAs

Tell me about what their first day looks like:

• Training
• Requesting Access
• Team Introduction

What previous job titles or background work will in this role?

• Sr Business Systems Analyst
• Data Scientist (in addition to Business Systems Analyst, not on its own)
• Developer with Business Analyst experience

Project Manager for a health plan, if they have the required knowledge

Required Skills/Experience:

1.

Health Care – Claims Processing Experience; hands-on experience reviewing and validating claims processing outcomes and the associated claims data

2.

Requirement Elicitation, Testing Experience

3.

SQL (Oracle, SQL Server, etc)

Preferred Skills/ Experience: