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Claims SME

The Computer Merchant, LTD.

(remote)

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JOB DETAILS
SALARY
$48–$50 Per Hour
JOB TYPE
Temporary, Contractor, Full-time
SKILLS
Analysis Skills, Budget Management, Bug Tracking/Defect Management, Business Analysis, Business Operations, Business impact analysis (BIA), Change Requests/Orders, Communication Skills, Cross-Functional, Data Analysis, Data Mapping, Documentation, Electronic Data Interchange (EDI), Federal Laws and Regulations, Functional Requirements Document (FRD), Functional Testing, IBM Rational ClearQuest, Knowledge Base, Management of Information Systems/Technology (MIS), Medicaid, Microsoft Excel, Microsoft Outlook, Microsoft SharePoint, Microsoft Word, Presentation/Verbal Skills, Pricing, Problem Solving Skills, Quality Assurance, Quality Assurance Methodology, Query Analysis, Regulations, Requirements Management, SQL (Structured Query Language), Software Development Lifecycle (SDLC), State Laws and Regulations, System Integration (SI), System Validation, Technical/Engineering Design, Test Plan/Schedule, Testing, User Interface/Experience (UI/UX), Waterfall Model of Software Development, Writing Skills
POSTED
20 days ago
JOB TITLE: Claims SME
JOB LOCATION: Remote
WAGE RANGE*: $48hr to $50hr w2
JOB NUMBER: 26-00767

REQUIRED EXPERIENCE:
Medicaid Management Information Systems (MMIS) in:
*Claims front end, back end, pricing, edits/audits, EDI
Requirements gathering and system design
Waterfall Software Development Life Cycle (SDLC)

JOB DESCRIPTION

A Technical Business Analyst (TBA) bridges the business (operation) needs and IT solutions to improve system efficiency and achieve the state business goals as well as end user experience.
TBAs require strong technical knowledge of systems and processes, along with excellent communication skills to translate business needs into actionable technical details and vice versa translating technical details in a way for the business to understand.

Daily Tasks Include:
  • Communicate with the client
  • Facilitate recurring/adhoc client meetings and project team meetings (dev/qa)
  • Ellicit and document functional business requirements and analyze impact of changes across the MMIS.
  • Facilitate design sessions and create detailed system design specifications to be used by the project team for implementation of new system requirements or software.
  • Assist in testing, defect resolution, and system implementation of change requests and defect fixes.
  • Collaborate with stakeholders (developers, testers, state, etc.) to resolve system issues (defects, heat tickets) and improve system functionality
  • Monitor task progress and compliance with scope, budget, and schedule

Knowledge Base Required:
  • Medicaid Management Information Systems (MMIS) in:
    • Claims front end, back end, pricing, edits/audits, EDI
  • Requirements gathering and system design
  • Waterfall Software Development Life Cycle (SDLC)
  • Creation of technical (design) documentation
  • Defect triage
  • Ensure IT solutions align with Medicaid regulations

Skills Required:
  • Exceptional analytical skills
  • Exceptional verbal and written communication and presentation skills
  • Ability to translate technical jargon into business-friendly language
  • Collaborate with developers, testers, and cross-functionally to validate system functionality
  • SQL for data querying and analysis
  • Strong understanding of system integration, data mapping, and testing processes

Tools:
  • SharePoint
  • Outlook
  • MS Word and Excel
  • SQL Developer
  • ClearQuest
  • Doors Next Generation (DNG)

Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities

* While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions. Benefits offered are in accordance with applicable federal, state, and local laws and subject to change at TCM's discretion.

About the Company

T

The Computer Merchant, LTD.