Job Description
Position Summary
The Business Analyst supports claim operations with process improvements and system enhancements across claims administration, benefits, provider data, and provider services. From discovery through implementation and validation, the Business Analyst helps improve processing accuracy, operational efficiency, and the member and provider experience.
Key Responsibilities
• Gather, analyze, validate, and document business requirements for claims, benefits, provider data, and member and provider inquiry processes.
• Evaluate current workflows, investigate processing errors, payment discrepancies, manual activities, and service issues, and recommend improvements based on rootcause analysis.
• Analyze claims, benefits, provider, and service data to identify trends, reconcile discrepancies, and report on accuracy, turnaround times, work inventory, and other operational measures.
• Partner with operations, technology, provider network teams, and vendors to clarify requirements, assess downstream impacts, and coordinate system and process changes.
• Maintain traceability among business needs, approved requirements, business rules, and test results, including changes related to provider contracts, and compliance guidance.
• Experience with core health plan administration platforms, electronic data interchange (EDI), provider reimbursement methodologies, or commercial, Medicare, or Medicaid products.
• Support implementation through procedure updates, and postimplementation validation of operational results.
• Track assigned deliverables, communicate progress, and escalate risks, issues, and dependencies promptly.
Qualifications
• Bachelor's degree in business administration, healthcare administration, or a related field, or an equivalent combination of relevant education and experience.
• Two or more years of experience in business analysis, process improvement, or a related role within a health plan, thirdparty administrator, or healthcare payer environment.
• Experience and working knowledge of health plan workflows, such as claims processing, benefit administration, or provider data management.
• Strong analytical and problemsolving skills, including the ability to interpret healthcare administrative data, reconcile discrepancies, identify root causes, and evaluate solutions.
• Proficiency with Microsoft Excel, Word, and PowerPoint, SQL and Tableau and familiarity with processmapping and collaboration tools.
• Strong written and verbal communication, meeting facilitation, and stakeholder collaboration skills.
• Ability to manage competing priorities, meet deadlines, work independently, and maintain accurate documentation.