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Claims Business Analyst
2 weeks ago
RESPONSIBILITY:Business Analysis:Gathers, reviews and analyzes Claims data to identify issues, and potential problems and solutions related to development and implementation, including but not limited to new products or services, contract deliverables, enhancements to add functionality and/or redesigns of systems, both manual and automated, to improve efficiency, financial models of costing and pricing. Utilize the data analysis skills and experience including but not limited to SQL queries to pull or download appropriate data or reports from processing systems required for the analysis. Develops forward thinking, data driven recommendations and strategies that align with business objectives and based on logical assumptions and facts considering resources, constraints, and Employer values.
Delivers critical pieces of analysis and research to drive new insights and actively and openly shares with appropriate parties to encourage collaboration for improvement and change. Translates analysis into solutions and/or options for consideration of specific actions, including business process improvements. Initiates change and evaluates impact.
Plans and executes all initiatives for maximum impact but minimal disruption to our key stakeholders. Promotes and processes product efficacy – translates large volumes of data, testing and experiments into clear recommendations and responses to constantly changing business environments. Provides quality, objective, and professional analysis.
Guiding Project Team and Operational Units:Engages and collaborates with project staff and subject matter experts with the planning and implementation of project and sub project work efforts. Supplies or advises in the development of requirements, reports, budgets, and other analyses, and help solve operational issues and roadblocks. Cross-Functional Integration and Communication:Engages closely with cross-departmental team members to complete tasks and provide status updates.
Works with the project team, other departments and external partners to monitor, collect, communicate, and distribute information. Communicates analysis, assessments, recommendations and completed work product through professional written and verbal reports and presentations effectively and cross-functionally. Conducts presentations to all levels of the organization (unit meetings, department meetings, management meetings, etc.) to ensure reporting of quality outcomes are consistent and understood.
Acts as a key liaison point for other departments and within Claims (e.g., Claims Production, IT, Configuration, etc.). Ensures cross-functional coordination and alignment. Business Testing:Coordinates testing needs and requirements with corporate testing unit.
Support the Business testing or User acceptance testing as needed, including but not limited to lead and/or coordinate the testing activities which may include gathering and generating test data, identifying test scenarios, status reporting, escalating issues, and performing validation and approval of testing results. OTHER DUTIES/FUNCTIONS:Performs other duties and accepts responsibility as assigned. Attends training as needed or assigned.
QUALIFICATION REQUIREMENTS5 years related experience in Healthcare Payer industry or Health insurance3 years related experience in Claims processing or Configuration support for Healthcare Payer or Health insuranceBasic knowledge of performing Claims analysis using SQL databasesExperience on HealthEdge / HealthRules Payer (HRP) or FACETS or QNXT Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or ***************
