The business analyst is responsible for configuring and testing the system to make sure new policies or configurations are implemented correctly.
The business analyst portal is the home page where the business analyst can access various configuration tools.
Business decisions and rules which can be configured include:
- Action codes – Directives for specific conditions such as VIP member, Employee member, split claim line.
- Event codes – Defined for claim suspends or claim holds. The business analyst can view all the event codes in the system, create new ones or update the configuration of an existing one. Event codes can be configured in the system to support the appropriate routing and disposition of claims.
- Module bypass settings – Settings to bypass specific modules for certain conditions.
- Test claims suite – Utility to create and store test claim data to validate specific business logic scenarios.
- Notifications – Create system messages to the user community. System Managers can also create notifications.
- Random audits – Seven audit categories defined in Smart Claims Engine where predefined criteria can trigger a pend code for routing to an appropriate work queue.
- Mass adjustment – The ability to adjust large volumes of claims. Claims may be suspended, approved to pay or already issued payments to providers.
- Skill configurations – The ability to configure the skills that can be assigned to a claim or claims inquiry.
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