Resp & Qualifications PURPOSE: Support Pricing Systems by analyzing provider pricing requirements and determining appropriate systemic processes, drawing on practices outlined for Functional Analysts. Prepare, execute, and document provider pricing test scenarios to ensure correct reimbursement methodologies and accurate configuration behavior across platforms (e.g., Facets, NetworX, FEP, Nasco). Conduct data validation and provider file reviews to confirm accurate claim payment outcomes and identify discrepancies before production release. Collaborate with Pricing Systems, Contracting, QA, and business teams to ensure pricing changes flow correctly through downstream systems.ESSENTIAL FUNCTIONS:Interpret business needs and issues by gathering, eliciting, analyzing, documenting and validating the Business areas user and technical (functional/non-functional) requirements. Under the direction of manager, participates in the creation of requirements documentation. Collaborates in the creation of project plans to define, organize and schedule requirements management and development activities. Participates in requirements analysis and verification sessions. Participates in the tracking and management of open issues and assists in planning for resolution. Participates in development sessions and design reviews in order to ensure design meets user requirements.Responsible for the overall success of user acceptance testing, including documentation, verification and release. Implements practices and procedures for end user test plans. Identifies and documents gaps in requirement adherence or system deficiencies/defects and coordinates appropriate action through issue resolution. Providing guidance and training to application end users. Identifies, documents and troubleshoots problems in systems, software and processes. Collaborate with appropriate stakeholders to monitor, report and resolve issues. Participates in the development of solutions and workarounds that solve low complexity technical, system and/or business issues. Reviews, analyzes and creates detailed documentation of business systems and user needs. Responsible for the written documentation of requirements in a clear and well organized manner. Develops and/or collaborates in key project and requirement deliverables for projects of low complexity.Monitors and reports project status to identify and mitigate risks and to ensure quality and timely deliverables. Coordinates assigned projects from concept through implementation. Prioritize and manage new work requests. QUALIFICATIONS:Education Level: Bachelor's Degree in Business, Information Technology, Computer Science or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.Experience: 3 years experience in functional, operational, business, data, systems or testing analysis.Preferred Qualifications:Demonstrated ability to deliver high quality, effective deliverables on-time and be a valuable contributor to the development of cost-effective solutions.Moderate understanding of business analysis core competencies. Knowledge, Skills and Abilities (KSAs)Strong time-management and organizational skill.Excellent communication skills both written and verbal.Ability to organize stakeholder meetings.Microsoft Office applications usage.Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.Salary Range: $59,472 - $118,118Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).Department Core Consolidation GovernmentEqual Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.Where To Apply Please visit our website to apply: www.carefirst.com/careersFederal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.PHYSICAL DEMANDS:The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.Sponsorship in US Must be eligible to work in the U.S. without Sponsorship#LI-LY1 PDN-a0f6fd1e-f21e-4405-9eb0-26a5ed6e5d03
