Healthcare Insurance BA (SME)

job
  • Damco Solutions
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Job Summary
Location
Plainsboro ,NJ
Job Type
Contract
Visa
Any Valid Visa
Salary
PayRate
Qualification
BCA
Experience
2Years - 10Years
Posted
26 Dec 2024
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Job Description
  • 10-12 years of Health SME (Subject Matter Expert) experience, Preferably in health care or health insurance industry
  • Health, Hospital/Wellness, Cancer, Critical Illness, MEC1- Skinny Limited Medical, MEC2 -Limited Medical, MEC3 -Limited Medical products expertise is a must in US region.
  • Proven experience with underwriting processes, policy admin s ystems, claims process, benefit configuration , Form generation, and integrations with down and upstream systems.
  • Proven experience in implementing Health portal s following ANSI EDI standards.
  • Experience with Health insurance systems for carriers and MGAs
  • Exposure to Medicaid and Medicare systems
  • Knowledge and Experience in billing, Claims, HIPAA regulations, EDI files
  • Proficiency in requirements gathering, process modelling and documentation
  • Ability to collaborate with stakeholders at all levels internally and clients
  • Familiarity with industry specific tools for policy administration, claims management and underwriting
  • Experience in integration of core system with portals and apps.
  • Extensive experience in functional integration with associated third-party systems

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