IT Business Analyst
Found in: Resume Library US A2 - 7 days ago
Scope of Responsibilities: This technical role will be responsible for helping support processes and solutions tied to ProActs Third Party administrator partners and B2B integrations. This role requires a strong understanding of PBM or TPA methodologies, concepts, and processes.
Job Summary: This position will help assist, create and troubleshoot partner integrations and processes using a combination of resources, methodologies, and applications. This position will also assist with new B2B integrations and support existing processes tied to file management and feeds and pharmacy claims remediation and health benefits.
Responsibilities:
Job Duties:
Responsible for working with new and existing partners in the support and administration of ProAct’s core processes which includes working with and supporting a variety of TPA (Third Party Administrators) electronic transmission of eligibility files, medical/Rx files and reporting requirements.
Work with TPA and clients to define/maintain/troubleshoot file feeds and customized layouts based on specific application.
Troubleshoot and analyze claims issues within raw data feeds and reports.
Help with test scenarios/files, test execution and test results validation.
Explain requirements and processes to internal/external technical and business partners in a variety of ways (use cases, logical diagrams, flow charts)
Meet with IT and partners to review requirements, address open issues/questions and close gaps.
Help represent all business interests in making sure technical requirements are understood and processes are met
Qualifications:
Education: B.S. in Business Administration, Business Analytics, or related field
Job Skills Required:
Proficient in using MS-SQL, SSRS
Strong understanding of medical or pharmacy claims processing
Identifying data quality issues and defining/implementing corrective actions
Coordinate activities, changes and communication with internal groups and business partners
Multitasking with the ability to handle multiple tasks, changing priorities in a fast paced, rapidly growing environment
Excellent verbal and written communication skills
Self-motivated with excellent customer service and problem solving ability
Special Conditions of Employment:
Drug test
Initial and continuous exclusion and sanction/disciplinary monitoring
Any and all additional eligibility requirements based on the specific position
Must sign and agree to the Elevated Privileges Acceptable User Agreement
Experience:
Must have 2-5 years of experience using a variety of applications that facilitate high volume electronic file transferring, data validation, extracting, parsing, creating and storing of different files
2-5 years in a B2B environment working with partners to achieve common goals
MS-SQL Server and relational database experience
Ability to translate business questions and partner requirements into systematic processes
Very Strong communication and problem-solving skills
Compensation:
$26.00-31.00/hr
The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.
KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.
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