Clms Bus Proc Anlyst Senior

Requisition Number: 2254640
Job Category: Claims
Primary Location: New Delhi, Delhi, IN

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As member of the GO Claims Readiness, the Claim Business Process Analyst position is responsible for testing & validating the setup of benefit packages and authorization rules, verifying claim system edits, third party tools, validating key system support tables, and ensuring overall end 2 end claim adjudication & processing accuracy, which would include gathering information in regards to business requirements, expectations for the project, and review or clarifying discrepancies. In this role you must have the ability to understand claim payment functions, table interdependencies, complex regulatory rules and market specific factors, with primary focus on developing & executing efficient & effective, project specific test plans for new and expanded Medicaid, Medicare and Individual Exchange programs.   

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

Training will be conducted virtually from your home. 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 

  
Primary Responsibilities: 

  • Creates and executes standard, repeatable test protocols to ensure configuration & claims payment accuracy and the timely identification and resolution of defects. 

  • Adheres to tight testing schedules tied to key project milestones.   

  • Executes testing on complex projects with overlapping deadlines. 

  • Maintains SOX-compliant documentation, including testing outcomes, defects, risks, change controls, issues and decisions. 

  • Identifies and solves gaps and bugs to reduce potential for pended claims and payment errors. 

  • Identify solutions and provides explanations and information to others on difficult issues. 

  • Ensures that system configuration adheres to Medicare, Medicaid, and other federal/state regulations. 

  • Manage workload to meet project deliverables and due dates. 

  • Perform other duties as assigned 

While this role has serious impact, it’s not easy. Deadlines can be intense and having a keen attention to detail is critical to maintaining workflow and project timelines. 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

 

Qualifications – Internal Required Qualifications: 

  • High School Diploma / GED (or higher) or equivalent work experience 

  • 2+ years of Claims, Configuration or Testing experience 

  • 1+ Medicaid and/or Medicare experience 

  • 1+ years Facets experience 

  • Working knowledge of both paper & electronic claim formats for HCFA & UB form types 

  • Beginner/Intermediate proficiency Microsoft Office (Outlook, Excel, Word)  

 

Qualifications – Internal Preferred Qualifications: 

  • SQL experience a plus 

  • Effective verbal and written communication and presentation skills 

  • Experience working in a project-driven environment 

Additional Job Detail Information

Requisition Number 2254640

Business Segment UnitedHealthcare

Employee Status Regular

Travel No

Country: IN

Overtime Status Exempt

Schedule Full-time

Shift Night Job

Telecommuter Position No

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