Must have very good understanding of the healthcare payer space with a minimum experience of 5 years in the domain.
Must have a prior experience in implementing/maintenance of commercial payer solution and/or Medicaid system
Must have good experience with claims processing concepts, along with the member enrolment and care management concepts.
Must be able to work with the clients to create/gather requirements and document them according to standards.
Must adhere to (or if needed, define) the processes for requirement solicitation, documentation and hand off.
Should work closely with the development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best in class solution.
Should have basic understanding concepts like web services, relational databases etc.,
Should be able to run queries and perform basic system analysis, RCA etc.,
Should be able to create mapping documents for the various interfaces and include business rules, transformation and DB mapping.
Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos
Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks
Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.