Vacancy description
Gainwell Technologies LLC
India, Bengaluru
Business Process Analysis SME (Medicaid Domain & C/Pro*C programming) in Bengaluru, India is listed on Jobeax. Browse 30,000+ vacancies available.
Seeking an experienced BPA SME with Medicaid domain expertise and strong understanding of MS MES Business Policy Administration. The candidate will be responsible for analyzing Medicaid policy requirements, translating policies into BPA rules, supporting Benefit Plans, Assignment Plans, Provider Contracts, and ensuring accurate claims adjudication through BPA configuration and governance.
The BPA SME will collaborate with Business Analysts, DOM SMEs, Operations, Reference teams, Developers, and Testing teams to design, configure, validate, and maintain BPA rule solutions. BPA supports claims adjudication, coverage determination, provider billing validation, reimbursement, audits, copays, and other insurance processing.
This role is strictly involved in application configuration and development activities and does not involve access to Protected Health Information (PHI), Personally Identifiable Information (PII), or any secured or confidential client data. The work is limited to ECM development, customization, integration, and support activities and does not include handling or processing of sensitive health or personal information.
Business Policy Analysis
• Analyze Federal and State Medicaid policy requirements.
• Translate policy requirements into BPA rule specifications.
• Create decision tables, rule mapping documents, and business rule specifications.
BPA Configuration Analysis
• Analyze and support:
o Benefit Plans
o Assignment Plans
o Provider Contracts
o Reimbursement Rules
o Copay Rules
o Audit Rules
o Form Edit Rules
Claims Processing Analysis
• Understand how BPA impacts claim adjudication.
• Analyze:
o Coverage determination
o Provider eligibility validations
o Provider contract validations
o Reimbursement processing
Rule Sheet Management
• Review and validate BPA Rule Sheets.
• Support BPA Rule Sheet release management process.
• Review approvals and configuration promotions.
• Perform rule impact analysis.
• Validate overlapping rule scenarios.
• Support BPA Rule Sheet governance.
Testing & Validation
• Create acceptance criteria.
• Develop BPA test scenarios.
• Perform policy compliance verification.
Functional Skills
• Medicaid Claims Processing
• Medicaid Policy Interpretation
• Benefit Plan Analysis
• Assignment Plan Analysis
• Provider Contract Analysis
• BPA Rule Analysis
• Requirements Gathering
• Impact Analysis
• Business Rule Documentation
Technical Skills
• SQL
• Oracle
• C Programming (working knowledge)
• Pro*C (working knowledge)
• Unix/Linux
• Data Mapping
• Query Analysis
BPA Knowledge
• Business Rules Editor (BRE)
• Rule Sheets
• Benefit Classifications
• Rule Metadata
• Rule Variables
• Benefit Plan Hierarchies
• Provider Contracts
• Rule Configuration Lifecycle
Preferred Skills
• MES/MESA Experience
• Medicaid Enterprise Systems
• Claims Adjudication Knowledge
• Provider Enrollment & Maintenance
• Reference Data Knowledge
• Rule Engine Experience
Remote opportunity
Similar vacancies
Gainwell Technologies LLC
... reference configuration impacts claims, provider enrollment, reimbursement, audits, and policy administration. Your role in our mission Required Technical Skills Programming Skills - C Programming - Pro*C - Oracle SQL - PL/SQL - Unix/Linux Shell Scripting - Batch Processing Reference/BPA Skills - BPA Configuration - Reference ...
India, Bengaluru
ChargePoint
... individuals. In alignment with this commitment, we ensure that persons with disabilities are provided with reasonable accommodations throughout the employment process. If you need a reasonable accommodation to participate in the application or interview process, to perform essential job functions, or to access any other benefits ...
India, India
300k
... tools (Tableau,Looker, or similar). Proficiency in Python or R for data analysis and modeling, with experience leveraging analytics to directly influence key business metrics. Deep experience with marketing analytics, cohort analysis, funnel analysis, and experimental design (including A/B and multivariate testing). Excellent ...
India, Mumbai
Accenture
784k
... will be accountable to manage the Supply Chain and provide insights which will help in increasing efficiency by doing away with waste and facilitating greater profits It also involves management of the flow of goods and services and including all processes that transform raw materials into final products The flow of tasks ...
India, Noida
orbitouch hr (orbitouch outsourcing pvt ltd)
... meet business requirements. Work closely with cross-functional teams to resolve business and process-related issues. Present findings, recommendations, and business insights to senior management. Support change management and continuous process improvement initiatives. Required Skills Strong Business Analysis & Requirement ...
India, Delhi
Hiring Squad
... https://jobeax.com/link/DjviyiPa6OtRi0au Skills & Experience : - 3 - 8 years of experience in Business Analysis, UAT, Test Management, or Business Testing.- Strong experience in UAT and business testing within Financial Services.- Experience in Financial Reporting, Finance Transformation, Regulatory Reporting, or Reporting Change projects.- Good understanding ...
India, Chennai
jubilant ingrevia limited
... sources for business decision making Assist new product & business development – Conduct global trade analysis, market sizing and demand estimation, competitor analysis, profitability analysis, feasibility and selection of new products for potential entry through under guidance from SBUH, interaction with sales team & product ...
India, Noida
Vakilsearch
Rs 5 - 9 lakhs p.a.
Responsibilities and Accountabilities: Elicits requirements using interviews, document analysis, requirements workshops, business rules analysis, metrics & KPI definition, use cases, and other BA tools and techniques as required. Works with the Account Management, Strategy, and Executive Leadership teams and clients to ...
India, Chennai
Hiring Squad
... https://jobeax.com/link/DjviyiPa6OtRi0au Skills & Experience : - 3 - 8 years of experience in Business Analysis, UAT, Test Management, or Business Testing.- Strong experience in UAT and business testing within Financial Services.- Experience in Financial Reporting, Finance Transformation, Regulatory Reporting, or Reporting Change projects.- Good understanding ...
India, Gurugram
Weekday AI
Rs 5 - 15 lakhs p.a.
... personable and easy to talk to, not a silent back-office profile GOOD TO HAVE: - Business/commercial awareness (costing, quotations, planning) - Manufacturing or SME exposure - Graduate in engineering / statistics / commerce with a strong quantitative bent Must-have skills Python, Business Process Mapping Good-to-have skills ...
India, Mumbai
wsp in india
73k - 73300
Rental Data Review and input into GLHIMS. Transfer of data into Valuation template. (Property and Assessment Data Collection Using Analyse (software), create comparable bundles. Collate floor plans, surveys, and as-built drawings from client or internal systems. Identify missing or unclear measurement information and flag ...
India, Bengaluru
9k
... strategic support to Account delivery leaders, and drive business growth and revenue targets through compelling digital solutions. Responsibilities include managing project progress and delivery quality, resolving issues, ensuring process alignment and quality of service, forecasting resource availability management and collaborating ...
India, Bengaluru
hola media group
... interpersonal skills Strategic thinking and the ability to develop and implement business plans to meet objectives Proficiency in using CRM tools and other sales-related technologies Prior experience in marketing, sales, or business development preferred Bachelor's degree in Business Administration, Marketing, or related field
India, Mumbai
100k - 300k
... leaders, run point on key business cases, simplify complex trade-offs, and ensure we're compounding in the right direction, What will you do Create and evaluate business cases, investment proposals, and ROI models to support strategic decisions Work with business heads to drive financial strategy and execution across high-impact ...
India, Bengaluru
Recruitment Room
$124800 USD - $166400 USD
Business Domain Expert — AI Model Evaluation Pilot Job Type: Independent Contractor Location: Remote Schedule: Flexible, short-term project Compensation: $60–$80/hour (approximately $124,800–$166,400 annualized , based on 40 hours/week) About the Opportunity We are seeking experienced professionals in Business Operations, ...
India
... also be contacted by independent search firms engaged to recruit on our behalf; emails from their employees should always come from their firm's applicable domain. We'll never ask for your banking information or any payment as part of the recruiting process. If something seems off or you're contacted by an unexpected third ...
India, Gurugram
... devising ideas that help businesses to help people. Responsible for providing engineering and technical support to production personnel to maximize quality and productivity of capsule manufacturing process. Determines and specifies optimum processing parameters for Hard Capsule Machines. Provide guidance, training, and technical ...
India, India
... consulting delivery. As an Consultant Engineering, you will support ERM's global consulting delivery by developing engineering designs for process remediation projects. You will work within the engineering team and partner with regional project teams to produce practical, safe, and technically sound project deliverables. ...
India, Delhi
Clean Harbors
... manner. Lost Reason Analysis & Corrective Actions: Analyze lost sales or account closures, identify key reasons for losses, and implement corrective actions to improve retention, reduce churn, and enhance conversion rates. Process Improvement & Strategy Execution: Identify opportunities for process improvement, introduce best ...
India, Pune