Business Operations Technical Analyst

Job Description

Provides system technical analyst support for claims testing processes for new plan and product implementations. The overall responsibilities include development of quality assurance testing strategies, developing testing specifications to validate business requirements and ensuring adherence to defined business unit policies and procedures.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Recommends and/or makes decisions regarding the development and execution of testing strategies for individual clients and general test scenarios used across broader market segments.
• Develops quality assurance testing strategies and quality testing specifications to validate business requirements.
• Reviews, analyzes, and evaluates business test systems and end-user needs.
• Performs process assurance functions to ensure testing requests and associated activities adhere to defined policies and procedures
• Defines and documents use requirements to assist in the development of custom test cases and develops test plans to support the requirement testing and validation phase.
• Acts as the liaison between the testing and validation end-users, Implementations and IT department. Partner with Implementation and Client Team Members to support the testing and validation requests for new product and plan implementations.
• Ensures client configuration programming is complete and accurate to defined specifications. Provide necessary support to software changes as well as ensures quality on-time deliverables.
• Assists internal department with technical claims testing setup.
• Provides direct support to the department in developing specification to create innovative tools and strategies for testing the coding and supporting structure of the pharmacy benefit plans to ensure accurate claims processing.
• Provides technical support for Point of Service (POS) testing of new rates and pharmacy carrier edits to ensure accuracy and integrity of data prior to production
• Provides proactive client test plan design analysis that establishes further opportunities for ensuring the integrity of the benefit, pharmacy network, formulary and other edits applied to a client's configuration for claims processing.
• Develops project plans, prioritize project tasks, and provide status updates on project progress.
• Works with business partners to develop and execute test plans for new client implementations, eligibility records, and benefit, group, & carrier linking.
• Analyzes claims adjudication results against requirements and identifies and reports discrepancies and inaccuracies. Makes recommendations and develops solutions to enhance the accuracy of POS system changes and configuration setups.
• Determines accuracy of adjudication configurations and approves data changes from the test environment to production
• Mentor and train team members and peers
• Lead the Testing and Validation team in solving new and unexpected problems that arise during the implementation phase of the project
• Appropriately improves processes, open to suggestions and experimentation, interested in re-engineering only when measurable benefits can be gained.
• Determines length and difficulty of tasks and projects, assigns task/people and anticipates problems or roadblocks.
• Serves as a subject matter expert for claims adjudication configurations and expected outcomes.
• Partners closely with Information Technology Data Programmers/ Analysts in development of advanced/complex programming of modifications that impact the testing environment.
• Provides recommendations for the maintenance of the claims testing environment.
• Proactively seeks out opportunities to improve claims testing processes through technology and process improvement solutions.
• Develops efficient SQL queries to research, gather data and identify solutions.

Supervisory Responsibilities

No supervisory responsibilities

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations;
Respond promptly to…