Business Analytics Advisor

As an enabler of Enterprise Strategic Priority for Medicare Advantage Growth, the DMOM program will drive a competitive administrative cost structure while delivering consistent, compliant operational performance.

This will be accomplished through the implementation of a new operating model - transformation across people, process, and technology.

The Business Acceptance Testing (BAT and UAT) tester is responsible for developing and executing testing to ensure results align to expectations.

This individual will report to the BAT Lead.

This individual will collaborate and communicate frequently with other BAT Testers or members of the technical and solution teams.

This individual must possess an understanding of business processes and capabilities.

This position supports the Provider Reimbursement/Claims Pricing, Capitation and Claims Intake team

Primary 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 proce...