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Company

The Cigna Group · 7 hours ago

Business Analytics Advisor

Tampa, FL

Full-time

Remote

Entry, Mid Level

2+ years exp

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Responsibilities

Prepare and create test scenarios that match real life claims processing.

Participate in analysis of business processes to drive test workflows.

Create and execute the testing of business process scenarios for all aspects of Medicare business including provider matching, provider fallout, member validation, enrollment, disenrollment, MOOP/OOP, benefit terms, Rules and Rates, procedure codes, appeals.

Assist in preparation of compliance testcases reviewing compliance controls using samples from previous audit findings, CMS program audit, HIPPA guidelines, CMS reports etc. Ensure the business scenarios are executed on the system to support high quality and compliant solution.

Create configuration testcases for product and benefit setup, COB, CMS mandates, EGWP, Service and procedure codes, Accumulators etc.

Coordinate with Business SME and Business process optimization to understand various aspects of business needs

Work with Test data and Test environment teams on deployment schedule for BAT environment readiness for testing

Coordinate necessary access on tools/platforms to enable BAT testing

Gain a deep working knowledge of Medicare business, IT landscape, and coordinate collaboration across BAT team

Drive automation where possible for all BAT testing in collaboration with BAT Automation Engineers

Identify and document defects, issues, risks and dependencies

Develop and execute test scripts, test conditions, input test data, and expected results for Business Acceptance Testing/ User Acceptance Testing

Prepare Production checkout plan, data and scenarios working with business SME and end users

Coordinate with Product Owner, Technical Leads, Product Managers and QA on readiness for release and timeline

Measure and report test coverage across all applicable coverage dimensions

Ensure appropriate testing tasks are scheduled during release, iteration planning

Participate proactively in daily standup meetings, story grooming sessions, team retrospectives and suggest improvements

Establish standard processes for managing end user feedback, triaging issues and routing to and from product and engineering.

Provide recommendations for Go/ No Go release decisions

Qualification

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Business Acceptance TestingQuality AssuranceClaims ProcessingHealthcare CodingSQLFACETSCollaboration Skills

Required

Bachelor’s degree or equivalent experience required

Two or more years of related business or healthcare experience.

Candidate should have strong claim processing understanding, and advanced knowledge of health care coding, fee schedules and reimbursement methodologies

Knowledgeable with high complexity, high volume transaction healthcare claim environment

Experience in Quality Assurance and/or Business Acceptance Testing

Knowledge of data model/database design concepts and working knowledge of SQL

Ability to work with shifting priorities to meet project requirements; self-motivated

Attention to detail, with strong analytical and problem-solving skills

Excellent written and oral communication skills

Experience working with multiple groups, both internally and externally – clients, engineering and product management teams

Ideal candidate will be resilient