Job Description

Title : Healthcare NSA Analyst

Remote

Job Type: Contract

Project description

• You will be part of a team responsible for testing healthcare claims processing, benefits, pricing, and related workflows for a non-profit healthcare organization in the US.
• The role is focused on validating local claims processing within HealthRules Payer (HRP), including EDI transactions, Blue Card claims, and HRP-to-TPA workflows.
• You will collaborate closely with Product Owners, Business Analysts, Developers, and QA team members across the US, India and Mexico.

Responsibilities

• Perform functional and end-to-end testing of healthcare claims processing within HealthRules Payer (HRP).
• Validate local claims processing workflows, business rules, benefits, pricing, and claims adjudication.
• Test and validate EDI 837 files and associated claims-processing workflows.
• Perform testing for Blue Card claims and related business scenarios.
• Validate HRP-to-TPA workflows, including upstream and downstream claims transactions.
• Create and execute test cases and test scenarios based on business and functional requirements.
• Analyze claims-processing results and identify inaccuracies or inconsistencies in business rules, configurations, pricing, and claim payments.
• Document, track, retest, and support resolution of defects identified during testing.
• Support investigation and resolution of production issues related to claims, benefits, and pricing configurations.
• Participate in business requirements and solution-review sessions to identify testing requirements and potential gaps.
• Collaborate with business and IT teams to validate system changes, enhancements, and configuration updates before production deployment.
• Provide subject-matter expertise regarding healthcare claims processing and HRP workflows.
• Maintain appropriate testing and system documentation.

Skills Must have

Mandatory Skills:

• Healthcare Claims Processing
• HealthRules Payer (HRP)
• EDI 837
• Blue Card
• Healthcare Domain Knowledge
• Claims Testing

Mandatory Skills Description:

• 4+ years of experience in healthcare claims processing, healthcare operations, or claims testing.
• Strong hands-on knowledge of local claims processing within HealthRules Payer (HRP).
• Hands-on experience working with and validating EDI 837 files.
• Experience with Blue Card claims processing and/or strong understanding of HRP-to-TPA workflows.
• Strong understanding of healthcare claims lifecycle, adjudication, benefits, pricing, and payment workflows.
• Good knowledge of healthcare and health-plan terminology.
• Understanding of relevant medical and industry-standard codes, including CPT, HCPCS, ICD-9/ICD-10, CDT, Revenue, and DRG codes.
• Experience creating and executing functional, integration, and end-to-end claims test scenarios.
• Ability to analyze claims-processing results, identify defects and configuration issues, and work with technical and business teams through resolution.
• Experience working with business requirements and translating them into comprehensive test scenarios.
• Working knowledge of Azure DevOps or similar test/defect management tools.
• Strong communication skills and ability to collaborate with business and technical stakeholders.
• Experience with BCBS Association requirements and Blue Card mandates.
• Experience with benefits and package pricing configuration in HealthRules.
• SQL knowledge for data validation and claims analysis.
• Experience troubleshooting production issues related to claims or benefit configurations.
• Previous experience supporting healthcare system migrations, integrations, or major HRP enhancements.
• Experience working with Third-Party Administrator (TPA) integrations and workflows.

Education:

Bachelor's degree in Business Administration, Management Information Systems, Computer Science, or a related field, or equivalent relevant professional experience.

Nice to have

Experience in Agile methodology and framework.

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