Business Analyst - Claims

Job Description

Role Summary: This job provides expertise for standard to moderately complex problem solving and in-depth understanding of system functionality. The incumbent reviews significant amounts of information and analyzes processes to support business unit needs. May troubleshoot errors, conduct impact analyses, and/or solve data rejection. Performs business analyses in one or more operational areas. Identifies process gaps and recommends process improvements for efficiencies. May provide guidance to Associate level employees. Essential Responsibilities Analyze Claims Tickets - Research/analyzes provider/Claims issue at hand Determines if provider/claim specific or global issue Actions taken could be ticket submissions to HMHS, pricing updates, provider file updates, collaboration with various internal stakeholders or Provider Relations, communications sent to Operations on global issues Requests cleanup report once issue is corrected, if required Follows cleanup through completion and notifies Provider Relations Facilitate process improvement meetings and/or discussions. Analyze the functions and operations of a business area/function and identify problem areas. Create process mapping and document current and future state business processes. Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies Assist in the development of desktop procedures and/or training material. Coordinate, monitor, and report on the progress of clean-up projects to ensure adherence to defined project schedule Communicate effectively with customers and colleagues. Successfully articulate issues, problems, and solutions. The experience we are looking to add to our team require: 6-8 years experience in Claims and Adjustments in Federal Employee Program (FEP) business Skills: Business Analysis skills Claims and Adjustment subject matter expertise Can adjudicate and adjust the claims Bluecard Home and Host knowledge Strong claims research skills are a must High level of systems and business knowledge Knowledge of INSINQ, Oscar, OCWA, CPBRE (Oscar Benefits), FEP Direct Business Process Improvement Collaborative Problem Solving Excellent analytical and problem-solving skills Bachelors or masters degree in any discipline Good verbal and written skills Good analytical and interpersonal skills Exceptional people management Good to have: AHM or any equivalent certification Additional quality/operational certifications Business acumen on Adjustments and Offset/Recovery