Senior Business Analyst Claims Operations

The Opportunity

The Senior Business Analyst, Claims Operations is responsible for gathering facts, documenting requirements, performing all aspects of claims testing, and ensuring gaps and risks are mitigated to produce the expected claim outcomes within the required timeframes. The Senior Business Analyst will be part of the Plan Build team and report to the Director, Claims Operations.

What you’ll do

• Gather and develop business requirements to ensure claim processing produces the desired outcomes.
• Build claim requirements and provide to other departments, vendors, and key stakeholders initiating other projects to ensure other stakeholders understand what the claims department needs to be successful.
• Develop claim test scenarios, procedures, and plans.
• Responsible for analyzing current business practices and systems and developing plans to optimize both practices and systems.
• Document results, findings, options, and proposed solution(s) with comparison to current state and changes required.
• Complete test procedures in the various test environments and upon test sign off validate specific outcomes continue within production.
• Lead the Investigation of reported incidents, including performing root cause analysis, communicating with affected stakeholders, and designing and implementing internal controls to prevent similar incidents from occurring in the future.
• Collaborate and coordinate with cross functional teams to identify and propose actionable solutions.
• Accountable to resolve issues, defects and concerns related to testing.
• Responsible for analyzing large data sets to find efficiencies and make recommendations on solutions to improve claims adjudication accuracy and timeliness.
• Effectively communicate with team members, vendors, and stakeholders.
• Oversee the test environments in collaboration with Plan build, IT and external vendors to ensure environment is refreshed and ready for successful execution of testing.
• Document outcomes and train others on developed solutions.

What we expect from you

• 3-5 years of Business Analyst experience supporting healthcare claims processing
• BA degree or equivalent experience
• Strong knowledge of Healthcare claims lifecycle
• Virtual Benefits Administrator (VBA) knowledge or proven experience in learning claims adjudication platforms
• Proven ability to effectively communicate with stakeholders
• Self-starter and the ability to work independently

We make healthcare EZ!

Additional Opportunity Details:

Target Base Compensation Range for this role is $78,000-$98,000K

• Factors that may be used to determine your actual salary include your job specific skills, education, training, job location, number of years of experience related to this role and comparison to other employees already in this role.

Employee benefits are part of the competitive total rewards package that HealthEZ provides to you. Our comprehensive benefits program includes health benefits, retirement plan (401k), paid time away, paid leaves (including paid parental leave) and more.

HealthEZ recognizes its responsibilities under federal, state, and local laws requiring non-discriminatory employment practices. All employment decisions, practices and procedures will be carried out without regard to race, color, creed, religion, sex (including pregnancy), sexual orientation, national origin or ancestry, age, marital status, disability, family status, status with regard to public assistance, or any other characteristic protected under applicable local, state, and federal laws.

HealthEZ is proud to be an equal opportunity employer.