• US Citizen

• Green Card

• Corp-Corp

• W2-Permanent

• W2-Contract

• Contract to Hire

• Consulting/Contract

• UG :- - Not Required

• PG :- - Not Required

• No of position :- ( 1 )

• Post :- 4th Jan 2024

The Senior Business Testing Analyst will perform activities that provide business solutions to complex organizational initiatives and should demonstrate an extensive expertise in the Claims platform and all interfacing applications. The person will play a key role in the configuration and implementation of new markets & products. They will be responsible for all Business Testing and documentation, using JIRA and other change management applications. The analyst will work with Leadership to ensure that realistic project scope is met as per project plans and timelines & escalate barriers for change requests.  The Senior Testing Analyst will collaborate with Leadership on Testing strategies and risk assessments.  They will be responsible for test case design and ensure clear and complete testing requirements by attending project meetings and collaborating with the Business SMEs, and/or PM’s.  Deliver weekly reports to Leadership on current testing statuses, along with identifying risks, roadblocks, and with the ability to offer solutions.

•         Possess a high degree of expertise in the business requirements that support governmental & commercial reimbursement policies and methodologies of the organization

•         Develop a thorough understanding of the Sentara Health Plans, supporting all Business/Operational areas

•         Perform complex testing, data analysis to identify and validate system configuration changes made to the claims processing platform as well as changes made to the ancillary claims systems (CES and 3M)

•         Perform complex testing, data analysis to identify and validate system configuration changes made Core processing platforms for all Business areas, including Salesforce, web portals, external vendor testing, and vendor management

•         Develop with Leadership the gold standard of test cases to empower the creation and maintenance of the Testing Center of Excellence (TCoE)

•         Demonstrate the understanding and need for robust and repeatable test cases for automation

•         Assess the needs of the change requests and translate them into test scenarios.

•         Demonstrate the ability to create custom SQL queries in SQL server databases.

•         Provides leadership and mentoring to other Business Testing Analysts as needed.

•         Assist in the writing of department policy and procedures

•         Strong analytical and critical thinking skills

•          Ability to plan, execute, and troubleshoot system and process testing

                                                                                                                                                                                                                               

Job Experience                                                                                                                                                               

8+ years in strong analytical roles preferred         Required            

5+ years’ experience in Medicaid, Medicare, and/or Commercial Healthcare Claims processing  Required            

 5+ years direct experience configuring and supporting Health Claims Systems on QNXT platform              Preferred               

 3+ years MS SQL server experience including writing SQL queries, SQL Server Analysis Services, SQL Server Reporting Services, SQL Server Integration Services              Preferred           

 3+ years project management experience          Preferred           

 3+ years SDLC or Change Management Process with JIRA, SNOW or other applications  Preferred           

 

 Additional Qualifications                                                                                           

•         Sound judgement and leadership skills

•         Strong organizational skills

•             Strong verbal and written communication skills with demonstrated ability to research, problem solve, trouble shoot, influence, present and partner across the organization

•         Proven ability to analyze data, processes, and initiate root cause analysis to influence corrective actions with leadership

•         Ability to retrieve and analyze complex data using Microsoft Access, Excel and SQL

•         Proficient knowledge of flow charting/process mapping, via Visio

•         Proven ability to work independently/in a team while managing multiple tasks and priorities

•         Demonstrated ability to independently lead multi-functional projects and serve as a resource for other members of the team

•         Strong knowledge of software implementation / development life cycle

•         Managed Care; Medicaid or Medicare Insurance

•         Functional knowledge of healthcare claim systems

•         Demonstrate functional understanding of healthcare enrollment periods for both Governmental programs and Commercial programs

•         Functional understanding of health care claim data sets such as ICD-9/10, CPT and HCPC; CMS and State 834, 837, 835, 270/271 and other EDI transactions as applicable