Description
26086-Claims Business Systems Analyst
Pasadena, CA 91101
Position type: w2
Contact duration: 6.6months + (Strong possibility of extension)
Client is heavily investing in new capabilities to support Health Plan claims processing. The HP Claims/EDI Solution Design Consultant will be responsible for all aspects of computer system design related to the implementation of new claims solutions and upgrades to existing ones. The ideal candidate will be a thought partner to internal business partners, information technology professionals and vendors. This is a technology position, but requires a strong business-focused background. The Solution Design Consultant will collaborate with business and IT partners in key areas: (1)understanding Claims Processing systems and their functional capabilities, (2) Helping business leaders understand business requirements and performing gap analysis relative to industry standards and future directions for strategic initiatives, (3) identifying, evaluating and recommending solution alternatives, (4) providing solution guidance to junior team members, (5) preparing cost estimates, (6) working with development organizations to ensure successful implementations of designed solutions. The ideal candidate will be able to work as part of the team when required as well as have the capability to lead technical tracks as needed.
Basic Qualifications:
A BA/BS in any field or 4 years of additional years of work experience.
10 years of progressive IT experience, with demonstrated success in software development, design and implementation of software applications in Health plans or managed care organizations.
5 years of experience in a senior solutions design role using software development life cycle methodologies including: Eliciting and documenting business and systems requirements from business partners and applying structured software life cycle & development methodologies (Agile, Waterfall, RUP, RM-ODP, RAD, etc.).
5 years prior consulting experience with an emphasis on delivery of complex enterprise solutions and experience.
Experience designing application components in a SOI/SOA environment
Preferred Qualifications:
Demonstrated experience in a senior solutions design or integration architect role using industry standard system development life cycle methodologies.
Demonstrated facilitation, collaboration, documentation, and presentation skills.
Demonstrated capability to work with both Technical and Business resources.
Demonstrated capability to lead a technical team towards a common project goal.
Ability to develop and maintain strong working relationships with Business and IT resources.
Deep technology and business acumen.
Excellent oral and written communications skills.
Excellent problem solving and "decision making" skills.
Healthcare or insurance industry experience is preferred.
Must have demonstrated success working in a Matrix team environment for a large organization.
Ability to understand business needs and translate them into solutions.
Self Motivated, Independent work capability.
Results orientation - Demonstrated ability to execute in a fast paced environment.
Experience designing solutions using web and SOA based architectures.
Experience working at a major consulting organization with an emphasis on delivery of complex enterprise solutions.
Experience evaluating software packages and working with application vendors and system integrators on Request for Information/Request for Proposals.
Experience working with vendors and systems integrators.
Top 3-5 Required Skill Sets:
Medical Claims Adjudication systems experience. This includes but is not limited to the Claims Intake, Member eligibility, benefits, provider demographic and pricing and all Financial Aspects
Systems Design and Architecture experience
Experience translating Business processes into Technology
Understanding and working knowledge of systems integration via web services (SOA/SOI experience)
Experience working in large, complex computing environments
Top 3-5 Daily Responsibilities:
Creating and updating System Architecture documents (logical and physical design) for a given Claims processing system subject area
Focal point for Design team interacting with Various Business groups as it relates to the physical implementation of their documented requirements.
Team liaison for Subject area relating to all interaction with Third party systems integration vendor. Activities include participating in technical design sessions, Approving technical sprint content for Agile team and ultimately approving their work.